R-6704
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RESOLUTION NO. 6704(CCS)
(CITY COUNCIL SERIES)
A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF SANTA MONICA APPROVING THE TOXIC CHEMICAL
DISCLOSURE FORM
THE CITY COUNCIL OF THE CITY OF SANTA MONICA DOES RESOLVE:
SECT ION 1.
Pursuant to Santa Monica Municipal Code Sectlon
5302(b), the attached Toxic Chemical Dlsclosure Form is approved.
SECTION 2.
The City Clerk shall certify to the adoption of
this Resolution, and thenceforth and thereafter the same shall be
in full force and effect.
APPROVED AS TO FORM:
~~~T'--
Robert M. Myers
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ADOPTED AND APPROVED THIS
14th
DAY
OF
June
t 1 9 83 .
C2 ~I~
MAYOR
I HEREBY CERTIFY THAT THE FOREGOING RESOLUTION
NO. 6704(CCS} _WAS DULY ADOPTED BY THE CITY COUNCIL QF THE
CITY OF SANTA MONICA ~T A MEETING THEREOF HELD ON
June 14
, 1983 BY THE FOLLOWING COUNCIL VOTE:
AYES:
COUNCILMEM8ERS: Conn, Epstein, Jennlngst Press,
Zane and Mayor Edwards
NOES:
COUNCILMEMBERS: None
ABSENT:
COUNCILMEMBERS: Reed
ABSTAIN:
COUNCILMEMiERS: None
ATTEST:
~~ERK
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TOXIC CHEMICAL DISCLOSURE FORM
. 1982 .
EXHIBIT A
PART A. Genera' Information. (Please Type or Pnnt)
1. BUSIness Name:
2. Contact Person:
3. Site AcId,..:
.. Mailing Address:
5. Phone Number:
.
6. City of Santa Monica Bul,"ess Ucens8 Number:
7 Category of BuSiness: (Check one or more applicable categories
Located in an 'ndustrial DistncL
Engaged In vehICle painting, rebuilding, recondlbonlng, body and fender work, repelnng and
overhauling. battery manufactunng, and the like.
Engaged in 'aundry, dry cteanlng, dye works. or carpet and rug clean,"g.
Engaged In photo or x.ray processing.
Engaged in metal or pJasbc cuttmg or forming.
Engaged In p"ntinQ, hthographlng, or similar processes.
Engaged in pest or weed control or abatement.
Engaged In medical, dental or chemica' laboratory.
Engaged In furniture refurbishing.
8. Oescnption of Stillness.
PART B. Statement of Disclosure.
Please check one.
No tOXIC chemicals to disclose. Proceed to Part E.
IndiVidual tOXIC chemical andlor product names to disclose.
Proceed to Part C andlor Part O.
Business Name:
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PART C. Identity of Toxic O1emlcals by O1emlcal Name. (P1e<!.Se type or print.)
TOXIC CH&MICA~ OUCRIIITION BY CHEMICAL NAME Ots. .aUAN- STORAGIl
'OSAL ITY
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LEGENDS:
DISPOSAL:
A- City ...... syatem
C- Offsite dilpoul
S- HOlding Tank
D= Other
QUANTITY:
A- Leu than 1 gallon
B- 1 - 10 gallons
C- 10 - 100 gallons
[)a More than 100 gallons
STORAGE.:
A= Container on Shelf
B= FIxed storage tank above ground
c= Drums or barrels
0= Fixed .torag. tank below ground
0= Other
, .
Business Name;
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PART D. Identity of ToxIc OIemials by Product Name. (Pfease type or print.)
PRODUCT NAMe MANUll'AC;TURttR DIS- 1 QUA,... i STO RAGE
POSA~ 'TV I -
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LEGENDS:
DISPOSAL:
A- City sewer system
Ca Off.ue disposal
B= Holding Tank
[):o Other
QUANTITY:
A- Less than 1 ganon
B- , . 10 gallona
C= 10.100~
0= More than 100 gallon.
STORAGE:
A= Container on Sheff
S= Fixed storage tent above ground
C" Drum. or barrels
D" Fixed storage tank below ground
a-Other
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PART E. Signature
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I certify that the above Information IS true and correct to the best of my knowledge.
Signature
Name (Please type or print)
Title
RETURN FORM ALONG WITH $5.00 FEE TO:
ToXIC Chemical Coordinator
General Services Department
1685 Main Street
Santa Monica. Catifoml8 90401
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