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COUNTY OF SAN JOAQUIN apU1N c _ OFFICE OF EMERGENCY SERVICES RONALD E. BALDWIN IV)POO. _;,tet .o ,,�.v ;4. 0 J Room 610, Courthouse DIRECTOR OF v. 1 222 East Weber Avenue EMERGENCY OPERATIONS • R' � AFB ��i Stockton , California 95202 Telephone (209) 468-3962 EW141 �c .?NINWALF'tEt T14Hazardous Materials Division (209) 468 -3969 HAZARDOUS MATERIALS DISCLOSURE SURVEY Please read the information on the reverse side before completing this survey form. A separate survey for each business name and/or address in San Joaquin County is required . Business Name : Constellation Brands / Woodbridge iliv' inery Business Owner(s) Name: Constellation Brands U , S . Telephone : 209 - 3695861 Business Address : 5950 E . jiloodbrid .Fe Rd . , Acampo , CA 95258 Mailing Address (if different from above) : P . O . B oX 12 60 , it o o dbr i dge , CA 95258 Nature of Business : :"linery Fire District: Liberty Ql . Ayes DNo Does your business handle a hazardous material in any quantity at any one time in the year? See the definition of hazardous material on the back of this form . If your answer is No, " go to Question 4 . Q2 . I'es DNo Does your business handle a hazardous material, or a mixture containing a hazardous material in a quantity equal to or greater than 55 gallons, 500 pounds, or 200cubic feet at any one time in the year? If "Yes, " how long have you handled these materials at your business? 30 yrs + If " Yes , " check any of the following conditions that applies to your business. DA . The hazardous materials handled by this business is contained solely in a consumer product, packaged for direct distribution to, and use by, the general public . DB . This business is a health care facility (doctor, dentist, veterinary, etc .) and uses only medical gases . DC . This business operates a farm for purposes of cultivating the soil , raising, or harvesting an agricultural or horticultural commodity . Q3 . AYes DNo Does your business handle an acutely hazardous material? See definition on reverse side of this form. Q4. DYes XNo Is your business within 1 ,000 feet of the outer boundary of a school (grades K- 12) ? I have read the information on this form and understand my requirements under Chapter 6.95 of the California Health and Safety Code. I understand that if I own a facility or property that is used by tenants, that it is my responsibility to notify the tenants of the requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. I declare under the penalty of perjury that the information provided on this disclosure survey is true and accurate to the best of my knowledge. Owner or Authorized Agent: X 111dro Jinn Crandell Date: 9/ 15126 Prime n e �I X /Ll !��XJ�-� Title : Facilities Director Signature F:\Devsys\Planning Application Forms Page 1 of 2 Hazardous Materials Disclosure Survey (Revised 8-25-03)