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San Joaquin County <br /> o,9,t;•- DIRECTOR <br /> Environmental Health Department Donna Heran,REHS <br /> r; <br /> ";Y <br /> s . <br /> �s � 1868 E Hazelton Avenue <br /> �o PROGRAM COORDINATORS <br /> Rn•1 i. . <br /> •.,�� Stockton, California 95205 Robert McCletlan,R[HS <br /> Jeff Cenuasoo,RENS,RDI <br /> � ' --- Kasay Foley,REHS <br /> n• .�` WebSite: vnvuv.$)gov.orgtohd IJnda Turkatte,REHS <br /> Phone: (209)468.3420 Rodney Estrada,REHS <br /> Fax: (209)468.3433 Adrienne Ellsaesser,REIis <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: Ameresco San Joaquin LLC Telephone: (209)825-3479 <br /> Business Site Address: 6484 N. Waverly Rd., Linden, CA 95236 <br /> Melling Address(if different from above): 111 Speen St., Ste 410, Framingham, MA 0170 <br /> Business Owner(s)Name: Ameresco San Joaquin LLC Telephone:_ (508)661-2200 <br /> Suslness Owner Address; 111 Speen St., Ste 410, Framingham, MA 01701 <br /> Nature of Business: Landfill gas to energy electrical generating est Arbistrlct: Linden Peters <br /> p(Y09 a No Does your business handle a hazardous material Ih Any quantity at any one time in the <br /> yead See the definition of hazardous material on page 2 of this form. <br /> X Yea ❑No Does your business generate,treat,or store a hazardous waste in any quant b/!(used oil, <br /> used antifreeze,waste solvent,etc.) <br /> If youramrwarls"Nos to both questions In Q1,please print,sten,and date fire bottom of this form and return to the address above. <br /> 02. X Yes o No Does your business handle a hazardous material, or a mixture containing a hazardous <br /> material,in a quantity equal to or greater then 55 gallons,600 pounds,or 200 cubic feet at <br /> anyone time In the year? <br /> If'Yee,how long have you handled these materials at your business? New business <br /> If'Yee,check any of the following conditions that apply to your business: ---- --- ---- <br /> o A The hazardous materials handled by this business are wntalned 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 commodlty. <br /> Q3, o Yes X No Does your business handle an Acutely Hazardous Material? See definition on page 2. <br /> Q4. 0 Yes X No Is your business within 1,000 feet of the outer boundary of a school?(Grades 1412) <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 responsiblllty to notify the <br /> tenants of the requirements which must be met prior to Issuance of a Certificate of Occupancy or beginning of operations. t <br /> declare under the penalty of perjury that the information provided on tills disclosure survey Is true and accurate to the best of <br /> my knowledge. <br /> Owner or Authorized Agent <br /> PdntName: /WaltB Hf Ch Date: August 14, 2014 <br /> Signature:_ Vv cue: Sr. Project Manager <br />