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SAN 10AHIN Environmental Health Department <br /> HAZARDOUS MATERIALS DISCLOSURE SURVEY <br /> A separate survey form Is required lar each businass name andlor address in Sari.laaquin Gouniy <br /> sustitiss Name' Griffith Energy Storage Project Tpleptrone: 206-265-0278 <br /> au5m=5s siteAddrwss. 17775 Midway Road, Tracy, CA 95377 <br /> Marling Address(rf rinferent from above). 700 Universe Blvd, Juno Beach, FL 33408 <br /> business C wner(s)Name: Griffith Energy Storage, LLC Telephone 205-2615-0278 <br /> Business OvifufAddfess: 700 Universe Bind, Juno Beach, FL 33408 <br /> Nature of ousiriess, Battery Energy Storage Project Fire District: Tracy Rural Fire District <br /> Q1 :Yes XNo Daus yc,ur business handle a hazardous material in any guaritity at any one line in the year? <br /> See the deflnitlon of hazardous matenal on page 2 of this form_ <br /> Yes Ix No Dues yuuf busnress generate,treat,or stere a hazaidouswaste in any quajit,ty?(used ml.used <br /> anilfreeze,waste solverii,etc.) <br /> 0 your answer is"No"go both questions in Q1,please print,sign,and date the bottom of this form and return to the address above. <br /> Q2 Yes IXNn Rues your business handle a hazardous material,or a mtKture cunlainrng a hazardous matenal, <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" Itieiv long have you handled these materials at your business's <br /> if'Yes",check any of the following conditions that apply to your busawss_ <br /> A, The hazardous materiars handred by this business are contamed solely in a consumer product <br /> packaged for dirert dlstdbulion to and use by the genera(public. <br /> B This husiness nperates a Farm for purposes of cultivating the soil, raising or harvesting an <br /> agncultural or horucukural commodity. <br /> Q3- Ye<_ xNu Dues yaw business hanndle an Aetltely Hazarduus h1atenal? See deknrllon on page 2, <br /> Q4 Yes Y No Is your busrnuss within 1.000 tees of the outer boundary of a school?(Grades K-12) <br /> I have read lite Inlotmatisut on flus Ipfm acid uWprsiand my requirements under Chapter 5.95 of the California Healtif and Satety <br /> Code(1-15C), I understand chat if I a-Am a facility or property that is used by tenants,it Is myrespnnslbitity 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 at pupury that the information provided on this disclosure survey is true acid accurate to the best of my knowledge. <br /> of you answered"Yes"to Question 2,please go online to %..nnv to subnot your hazardous materials Information. <br /> Owner or Audhonzud Agerd: <br /> NMId Nartiu- s Date. <br /> Signature TiIIe- <br /> lEtSs E HaZettnn AVenrle I Slocktorl,Cdhfumta 9=205 T 21-113 46F-14-10 I F Z09 404-0138 1 vwww slcefld.conn <br />