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"(( - ;. SAN�JOAQUIN Environmental Health Department <br /> �LP-F''N_ 'r`� COUNTY <br /> ,,..,. Greutn csr prowz here. <br /> HAZARDOUS MATERIALS OtSCLOSV RE SURVEY <br /> A sapareta survey form Is requhatl for each business name and/or atldrass in San Joaquin County. <br /> ausiness Neme:DDS Digester, LLC Telephone: <br /> Business seta Atltlress: 23335 �odds'Rtl, Escalon, CA <br /> Mailing Atltlrass(if different Tram above): �588 N Batavia St, $ta t C <br /> Business ownar(a)Nama:Sierra Renewable Organics Managa�Talaphona: 800-859-6'163 <br /> Bueinass owner Address: 1588 N Batavia St, Sta �C, Orange, CA 92967 <br /> Nature of Basinass:Dalry Fba oistrmc Escalon Consolidated FirP� <br /> 01. �Vas v No Doas your business handle a hezartlous materlal in a andty at any one time In the yaar9 <br /> Sae the tlefinlHon of hazardous materlal on page 2 of this form. <br /> o Yas �No Doas your business generate,treat,or store a hezartlous waste in env cuandtv4(used oil,used <br /> an[Ifraaza,waste solvent,etc.) <br /> IT yow anewar le"No"to both quaatlona In O'1,please prinq sign,antl de[v[ba bottom o1 thly Iorm vnd return to gi¢vddrava above. <br /> 02. �Vas v No Ooea your business hentlle a hazardous materlal.or a mixture containing a hazardous materlal, <br /> In a quantity equal to or greater than 66 gallons.600 pountls,or 200 cubic feet at any one lima <br /> in[ha year4 <br /> If"Yas",how long have you hantllatl these materials at your busineas� Continuously <br /> If"Yas",chock any of iha following contlitions that apply[o your business: <br /> v A. TM1e hazardous materials handled by this business ora contained solely In a consumer product <br /> packaged for tllrect tllstributlon to and use by iha general public. <br /> o B. This business operates a fano Tor purposes oT cultivating the Boll. raising or harvesting an <br /> agricultural or horticuhural commodity. <br /> OS, v Ves r.No noes your business handle an Acutely Hazardous Material? Baa tlafinitlon on page 2. <br /> Q4. o Vas �No Is your business within 1,000 Test of the outer boundary of a school?(Gratlev K-l2) <br /> I have read the information on this form and understand my requirements under Chapter 6.96 of[he Cellfomla Health antl Safety <br /> Code(HSC). I understand fhai If I own a facility or property tM1at la used by tenants,It Is my responsibility to notify the tenants of the <br /> requirements which must be mat prior to Isauanca of a Certificate of Occupancy or beginning of operations. I tleclare untler the <br /> penally of perjury that the Information proyltlad on ihla disclosure survey is true and accurate to the bast oT my knowletlge. <br /> If you answered"Vas"to Ouastlon 2, please go online to cars caleoa v[o submit your hezartlous materials information. �S� <br /> Owner or Authodzetl Agent �`� <br /> �-ti1 <br /> adm Name:Jack P OeLiddo Data: June 6th, 2023 ��. <br /> ���.E9%-�-1 Owner � <br /> Signature' ♦ Tltia: <br /> �S <br /> ���. <br /> L <br /> t B68 E. Hazelton Avenue I Stockton, California 95205 I T 209 46B-3420 I F 209 4B4-Ot 38 I www.$)cehd.com <br />