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% SAN JOAQUIN COUNTY '0181m <br /> CCaouittnglHtd IIepC <br /> OFFICE OF EMERGENCY SERVICES 0181m9E f <br /> HAZARDOUS MATERIALS DISCLOSURE SURVEY <br /> �cfae'A`' <br /> P�1 EASE PRINT OR TY? <br /> al. ' Please provide a separate survey for sect business name and/or address in San Joaquin Counry: <br /> a. Business Name: Farmington Packing Company <br /> b. Business Owner(s) Name: See Attached Phone- (209) 983-9700 <br /> C. Facility Address- ' 7735 State Route 99, West Frontage Road <br /> StockLoi,L, CI' 4 -..'_a 95206 <br /> d- Mailing Address' 1755 hl. Hammer Lane, Suite 12 <br /> Stockton, California 95209 p <br /> 4. Nature of Business: Fruit and Produce Packing Fire District: )l� <br /> I. Business Lie. No: applied for Expires (Mo/Yr) Standard Indstrl Code No: <br /> g- Proposed Project' Fruit and Produce Packing Facility <br /> 02. Oces your business handle a hazardous material? 'Hazardous Materfal- means any material that because <br /> of its quantity, concentration, or physical or chemical characteristics, poses a significant present or potential hazard <br /> :a human health and safety Or to the environment if released into the workplace or the environment (Includes fuels, <br /> petroleum products, paints, propane, oxygen, ammonia (EHS), chlorine (ENS), pesticides, fertilizers, and hazardous <br /> wastes...). <br /> Yes © No ❑ <br /> 03. If you answered 'YES to Cuestion 2 above: Do you handle a hazardous material or a mixture containing a <br /> hazardous materialau tfty equ Wor star than 55 gallons, 500 pounds, or 200 cubic feet at any one time? <br /> i <br /> Yes - <br /> Ny <br /> 04. Will the owner, appli`I cr future building occupant handle an Acutely Hazardous Material? (List of Acutely <br /> Hazardous Materials available at the Planning Oeoanment). <br /> Yes N5 No XQ <br /> OS. Will proposed buil ding or modified faciffty be within 1,000 feet of the outer boundary of a school (grades K-12)? <br /> Yes ❑ No U <br /> I have read the Hazardous Materials lnlomtation Guide (on back page) and understand my raquiraments under Chapter <br /> 6.95 of the California Health and Safety Code Secdons 25505, 25533, and 25534. 1 understand that if the building does <br /> not c-.lrrently have a tenant that it is my responsibility to notify the Occupant Of the requirements which must be met <br /> prior to issuance at a Certificate Of Occupancy. I declare under the penalty at perjury that this dfsa'osure Survey is <br /> true and accurate to the best of my knowledge and is made in the City of Stockton _ California. <br /> Owner or Auth Agent: <br /> (Print) N. ccart Tbe President - <br /> ;Slgnuwq Oara <br /> I. San doaqul Air Po non cantrol Dlsuict �, -2.- OMda at t(mergency Services <br /> 23Y1 YID Washington 3t, suits 1 FEE f _Maardous Yavrlsis O1Vl3len <br /> 3toc%wk CA !3263 (2411) 469-3t70 2'S3 E- Wstr.r Ave- Caurmauaa-Am 51a <br /> - -- Staettan, CA95262 (269) 446-3969 <br /> �7 i <br /> OEM IN P - ATE L <br /> APPRGVE R VEAIFlPD <br /> NYYP — RYPP— EICEYPT— - V.5.6192 <br />