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SAN JOAQUIN COUNT`( P€annilig[E q Dept. <br /> l OFFICE OF EMERGENCY SERVICES Mie No . : S',4 :9 7 <br /> . �. ; HAZARDOUS MATERIALS DISCLOSURE SURVEY <br /> QCi cpRa` <br /> PLEASE PRINT OR TYPE <br /> al. Please provide a separate survey for each business name and/or address in San Joaquin County: <br /> a. Business Name: Sunseeds L.T.D. L.P. <br /> b. Business Owner(s) Name: Sunseeds L.T.D. L. P. Phone: .209-367-1187 <br /> C. Facility Address: 7087 East Peltier Road <br /> Acampo, California 95220 <br /> d. Mailing Address: Same As Above <br /> e. Nature of Business: Vegtabl e Seed Resear.nhr Farm Fire District: Woodbni dge Dist. <br /> f. Business Lic. No: 1663 Expires (Mo/Yr) 12/92 Standard Indstrl Code No: Aq RI,S�, <br /> g. Proposed Project: Es.tab:hlsft.;zdsW.3�gtabla isised! research'"s:tati.on. <br /> 02. Does your business handle a hazardous material? "Hazardous Material" means any material that, because <br /> )f its quantity, concentration, or physical or chemical characteristics, poses a significant present or potential hazard <br /> .o human health and safety or to the environment if released into the workplace or the environment. (Includes fuels, <br /> petroleum products, paints, propane, oxygen, ammonia (EHS), chlorine (EHS), pesticides, fertilizers, and hazardous <br /> wastes...). <br /> Yes ❑X No ❑ <br /> 03. If you answered 'YES' to Question 2 above: Do you handle a hazardous material or a mixture containing a <br /> hazardous material in a quantity equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet at any one time? <br /> Yes ® No ❑ <br /> 04. Will the owner, applicant, or future building occupant handle an Acutely Hazardous Material? (List of Acutely <br /> Hazardous Materials available at the Planning Department). <br /> - Yes ❑ No El <br /> 05 Will propesad building or modified facility be within 1,000 feet of the outer boundary of a school (grades K-12)? <br /> Yes ❑ No X❑ <br /> I have read the Hazardous Materials Information Guide (on back page) and understand my require- <br /> ments under Chapter 6.95 of the California Health and Safety Code Sections 25505, 25533, and <br /> 25534. 1 understand that If the building does not currently have a tenant, that It Is my responsi- <br /> bility to notify the occupant of the requirements which must be met prior to Issuance of a <br /> Certificate of Occupancy. <br /> Owner or Authorized Agent: <br /> ;Print) /�/ L�CJ/�a Titlet�P`G//OyS <br /> ;Signature) < ��A( �L_ Date 7 <br /> San Joaquin Air Pollution Control District 2. Office of Emergency Services <br /> 2321 W. Washington St., Sults 1 Hazardous Materials Division <br /> Stockton, CA 95203 (209) 468-3470 222 E. Weber Ave., Courthouse-Rm 610 <br /> Stockton, CA 95202 (209) 468-3969 <br /> OES INSP DATE _/_/_ <br /> APPROVE REJECT VERIFIED _ <br /> HUMP RMPP EXEMPT_ V.3.0192 <br />