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42200151 <br /> SAN J O A Q U I N Environmental Health Department <br /> COUNTY---- <br /> (1rl'n n('sf. q owt <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; Podesta Farms Telephone: (209) 887-3701 <br /> Business Site Address: 8100 N. Podesta Lane,Linden, CA. 95236 <br /> Mailing Address(if different from above): 8000 N. Podesta Lane, Linden, CA. 95236 <br /> Business Owner(s)Name:Fred Podesta,Victor Podesta,&Tara Podesta Bryant Telephone: (209) 887-3701 <br /> Business Owner Address: 8000 N. Podesta Lane, Linden, CA. 95236 <br /> Nature of Business: Fruit and Vegetable Packing Fire District: Linden-Peters <br /> Q1, a Yes ■No Does your business handle a hazardous material in any quantity at any one time in the year? <br /> See the definition of hazardous material on page 2 of this form. <br /> n Yes ■No Does your business generate,treat,or store a hazardous waste in any quantity?(used oil,used <br /> 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. o Yes ■No Does your business handle a hazardous material,or a mixture containing a hazardous material, <br /> in a quantity equal to or greater than 55 gallons,500 pounds,or 200 cubic feet at any one time <br /> in the year? <br /> If"Yes",how long have you handled these materials at your business? <br /> If"Yes",check any of the following conditions that apply to your business: <br /> n A. The hazardous materials handled by this business are contained solely in a consumer product <br /> packaged for direct distribution to and use by the general public. <br /> n B. This business operates a farm for purposes of cultivating the soil, raising or harvesting an <br /> agricultural or horticultural commodity. <br /> Q3. n Yes ■No Does your business handle an Acutely Hazardous Material? See definition on page 2. <br /> Q4. n Yes ■No Is your business within 1,000 feet of the outer boundary of a school?(Grades K-12) <br /> I have read the information on this form and understand my requirements under Chapter 6.95 of the California Health and Safety <br /> Code(HSC). I understand that if I own a facility or property that is used by tenants,it is my responsibility to notify the tenants of the <br /> requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. I declare under the <br /> penalty of perjury that the information provided on this disclosure survey is true and accurate to the best of my knowledge. <br /> If you answered"Yes"to Question 2,please go online to cers.calepa,ca.gov to submit your hazardous materials information. <br /> Owner or Authorized Agent: <br /> Print Name: 1 n tD S/Ip— Date: <br /> Signature: LV/r— Title: 21? <br /> Zz <br /> TArCL, //Peder � A - 9 ya.� � <br /> �,,�.i Imo a_1 A- <br /> V cc.. o r Co 2q /12— <br /> rZ <br /> 1868 F. Hazel on Avenue Stoc for California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />