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San Joaquin County <br /> �O.P' COG Environmental Health Department °Donna OHeran,REHS <br /> z y 1868 E Hazelton Avenue <br /> vain I •�� on <br /> PROGRAM COORDINATORS <br /> Stockton, California 95205 Robert McClellon,REHS <br /> Jeff Carruesco,REHS,RDI <br /> • Kasey Foley,REHS <br /> Website: www.sjgov.orglehd Linda Turkatte, REHS <br /> Phone: (209)468-3420 Rodney Estrada,REHS <br /> Fax: (209)468-3433 Adrienne Ellsaesser,REHS <br /> HAZARDOUS MATERIALS DISCLOSURE SURVEY <br /> A separate survey form is required for each business name and/or address in San Joaquin County. <br /> Business Name: MUSCO FAMILY OLIVE CO Telephone: 209-229-7055 <br /> Business Site Address: 17950 VIA NICOLO RD TRACY, CA 95377 <br /> Mailing Address(if different from above): <br /> Business Owner(s)Name: FELIX MUSCO Telephone: 209-836-4600 <br /> Business Owner Address: 17950 VIA NICOLO RD TRACY, CA 95377 <br /> Nature of Business: OLIVE PROCESSING AND CANNING Fire District: <br /> Q1. iXYes o No Does your business handle a hazardous material in any quantity at any one time in the <br /> year? See the definition of hazardous material on page 2 of this form. <br /> XYeS No Does your business generate, treat, or store a hazardous waste in any quantity? (used oil, <br /> used antifreeze,waste solvent. etc.) <br /> If your answer is"No"to both questions in Q1,please print,sign,and date the bottom of this form and return to the address above. <br /> Q2. (Yes J No Does your business handle a hazardous material, or a mixture containing a hazardous <br /> material, in a quantity equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet at <br /> any one time in the year? <br /> If"Yes", how long have you handled these materials at your business? ~15 YEARS <br /> If"Yes", check any of the following conditions that apply to your business: <br /> ❑A. The hazardous materials handled by this business are contained solely in a consumer <br /> product packaged for direct distribution to and use by the general public. <br /> ❑B. This business operates a farm for purposes of cultivating the soil, raising or harvesting an <br /> agricultural or horticultural commodity. <br /> Q3. e Yes [(No Does your business handle an Acutely Hazardous Material? See definition on page 2. <br /> Q4. ❑Yes XNo Is your business within 1,000 feet of the outer boundary of a school?(Grades K-12) <br /> f <br /> I have read the information on this form and understand my requirements under Chapter 6.95 of the California Health and <br /> Safety Code (HSC). I understand that if I own a facility or property that is used by tenants, it is my responsibility to notify the <br /> tenants of the requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. <br /> declare under the penalty of perjury that the information provided on this disclosure survey is true and accurate to the best of <br /> my knowledge. <br /> Owner or Authorized Agent: <br /> Print Name. DENNIS LEIKAM Date: DECEMBER 20, 2017 <br /> Signature: Title: ENVIRONMENTAL MANAGER <br />