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• • �3L 13�a8� <br /> a N San Joaquin County <br /> C1 <br /> Environmental Health Department DD on OHeran,REHS <br /> y. 1868 E Hazelton Avenue PROGRAM COORDINATORS <br /> Stockton, California 95205 Robert McClellon,REHS <br /> Jeff Carruesco,REHS,RDI <br /> cq P Kasey Foley,REHS <br /> <rF°Ra Website: www.sjgov.org/ehd Linda Turkatte,REHS <br /> Phone: (209)468-3420 Rodney Estrada,REHS <br /> Fax: (209)468-3433 Adrienne Elisaesser,REHS <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: Delicato Vineyards Telephone: 209-824-3600 <br /> Business Site Address: 12001 S . Highway 99, Manteca, CA 95336 <br /> Mailing Address(if different from above): <br /> Business Owner(s)Name: Delicato Vineyards Telephone: 209-824-3600 <br /> Business Owner Address: 12001 S. Highway 99, Manteca, CA 95336 <br /> Nature of Business: Wine Manufacturing Fire District: <br /> Q1. VYes ❑No Does your business handle a hazardous material in any quantity at any one time in the <br /> year? See the definition of hazardous material on page 2 of this form. <br /> Yes ❑No Does your business generate,treat, or store a hazardous waste in any quantity?(used oil, <br /> Ilused 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. s o No Does your business handle a hazardous material, or a mixture containing a hazardous <br /> V� material, in a quantity equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet at <br /> any one time in the year? <br /> If"Yes",how long have you handled these materials at your business? .0&&a <br /> If"Yes",check any of the following conditions that apply to your business: <br /> c A. The hazardous materials handled by this business are contained solely in a consumer <br /> product packaged for direct distribution to and use by the general public. <br /> o B. This business operates a farm for purposes of cultivating the soil, raising or harvesting an <br /> agricultural or horticultural commodity. <br /> 03. a Yes `KNo Does your business handle an Acutely Hazardous Material? See definition on page 2. <br /> Q4. ❑Yes bNo 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 <br /> Safety Code(HSC). I understand that if I own a facility or property that is used by tenants, it is my responsibility to notify the <br /> tenants of the requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. I <br /> declare under the penalty of perjury that the information provided on this disclosure survey is true and accurate to the best of <br /> my knowledge. <br /> Owner or Authorized Agent: <br /> Print Name: Matt Belair Date: 10/16/2013 <br /> Signature: , , Title: Director of Technical Operations <br /> 1 <br /> swwanromz <br />