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v <br />.. - <br />COUNTY OF SAN JOAQUIN <br />OFFICE OF EI ERbENGY SERMCES' <br />Room 610, Courthouse <br />222 East Weber Avenue <br />Hazardous Materials Division (209) 468-8969 <br />HAZARDOUS MATERIALS DISCLOSURE SURVEY <br />RECD LVED <br />NOV 0 4 2013 7 }> <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />lease read the information on the reverse side before completing this survey form. A separate surgey,for each business name <br />nd/or address in San Joaquin County Is required. <br />uslness Name: Sutter Home Winery, Inc. <br />usiness Owner(s) Name: Robert D. Torres Telephone: 707-963-3104 <br />usinessAddress: 18667 Jacob Brack Rd., E6dn, CA 95242 <br />al ngPddurss4fdYesdrEfromatwyej P.D_ Box .2.48, Saimt.Halena, CA. 44574, <br />ature of Business: Winery Fire District: Thoroton <br />1. $Yes O No Does your business handle a hazardous material fn,any quantity at any one time In the year. See the <br />definition of hazardous material on the back- of this form. If your answer Is 'No; go to Question 4, <br />2. UYes 0 No Does your business handle a hazardous material, or a mbdure containing a hazardous material In a quantity <br />equal to or greater than 56 gallons, 600 pounds, or 200c any one time In the year <br />If'Yes,'how long have you band led these materials at your business? 7 Years <br />If'Yes,' check any of the following conditions that apply to your business. <br />OA. The hazardous materials handled by this business la contained solely in a consumer product, packaged for <br />direct distribution to, and use by, the generatpubltc. <br />OR. ThWbuslness is a health care facillty (doctor, dentist, veterinary,, etc.) and usds 9_UI medic4gases. <br />OC. This business operates a farm for purposes of cultivating the soil; raising; or harvesting an agricultural or <br />horticultural commodity. <br />3. Mes ONo Does your business handle an acutely hazardous mQterle19 See deflnition on reverse side of this form. <br />I. ❑Yes 2gNo Is your businesswithin 1,000 feet of the outer boundary of a school (grades K-12)? <br />ave read the Information on. this form. and undersWd my r"ufremenW under Chspter 6.gb of thQ.Calfjomia.Meallry.end:Sa(et� <br />-de_ I understand that if I own.a facility or property that -Js used by tenants, that it lstny <br />responsibility to notify the tenants of the <br />ruirements which must -be met pdor4o Issuance of a Certificate of Occupancy cir.beginntng of operatibns. I declare under the <br />natty of perjury ttiat the Information provided on this disclosure survey Is true and.accurate.to the-bestof my knowledge. <br />mer or Authorized Agent: <br />Eric Jenssea <br />Na' e <br />Sign urs Tide: Vice President 6f Engineering <br />oo+wwvonwr�ox w_caaacwaocro.�var<+.e io,o z Page 4 of 5 <br />