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t4VIM i s i t F 4 J -• <br /> a� SAN jOAQU1N COUNTY Ptanriing[Bk�g_Dept <br /> OFFICE OF EMERGENCY SERVICES EEa_..LYa. <br /> HAZARDOUS MATERIALS DISCLOSURE SURVEY Sl -p <br /> PLEASE PgINT )R TYPE <br /> 01. Please provide a separate survey for each business name and/or address in San Joaquin County: <br /> a. Business Name: Farmington Fresh, Inc. <br /> b. Business Owner(s) Name: Patrick McCarty - President Phone: (209) 478-1957 <br /> C. Facility Address: 7735 South Route 99, West Frontage Road <br /> Stockton. CA <br /> d. Mailing Address: 1755 W. Hammer Lane, Suite 1112 'n� <br /> Stockton. CA 95209 <br /> e. Nature of Business: Agricultural Fire District:. Y d r, i e' Lk.i+t. <br /> f. Business Lic. No: Expires (MoiYr) Stannard-hrdiRrf�—N <br /> g. Proposed Project: Fruit Packing Facility <br /> 02. Does your business handle a hazardous material? "Hazardous Material- means any material that, because <br /> of its quantity, concentration, or physical or chemical characteristics, poses a significant present or potential hazarn <br /> :0 human health and safety or to the environment if released into the workolace or the environment (Includes fuels, <br /> petroleum products, paints, propane, oxygen, ammonia (EHS), chlorine (EHS), pesticides, fertilizers, and hazardous <br /> Wastes...). <br /> Yes Q No ❑ <br /> 03. If you answered 'YES" to Question 2 above: Do you handle a hazardous material or a mixture containing a <br /> hazardous material in a quantity equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet at any one time? <br /> Yes ❑ N0 El <br /> 04. Will the owner, applicant, or future building occupant handle an Acutely Hazardous Material? (List of Acutely <br /> Hazardous Materials available at the Planning Department). <br /> Yes ❑ No ❑ <br /> Q5. Will proposed building or modified facility be Within 1,000 feet of the outer boundary of a school (grades K-12)? <br /> Yes ❑ No ❑ <br /> I have read the Hazardous Materials Information Guide (on back page) and understand my requirements under Chapter <br /> 6.95 of the California Health and Safety Code Sections 25505, 25533, and 25534. 1 understand that if the building does <br /> not currently have a tenant that it is my responsibility to notify the occupant of the requirements which must be met <br /> prior to issuance of a Certificate of Occupancy. I declare under the penalty of perjury that this disclosure survey is <br /> true and accurate to the best of my knowledge and is made in the City of California- <br /> Owner or Authorized Agent: <br /> (Pant) Gt4�-�, �-t - 2 c���-m. C.�. ,.,c, Tu. •�L•��� ( <br /> Date \1:A1 `�- <br /> I. San Joaquin Air Pollution Control District 2. office of imargency servless <br /> 2321 VC Washington St, Suite 1 Hazardous Materials Division <br /> Stockta t, CA 93203 (209) 4"3470 222 E. Woo" Ave— Ccutthouse.RM 610 <br /> Stocitran, CA 95202 (209) 468-3969 <br /> CES IMSP DATE _1/24 c( ' <br /> APPROVE REJECT _ V IFIED _ <br /> HUMP _ RMPP _ E]:ENPT_ V.S.0192 <br />