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RECEIVE® <br /> San Joaquin County DIRECTOR 2 2014 <br /> 0. <br /> Environmental Health Department 'TWROMMENTAL <br /> 1868 E Hazelton Avenue <br /> PRO G 49 kift MR WFI15,WE NIT <br /> Stockton, California 95205 Robert McClellon,REHS <br /> Jeff Carruesco,REHS,RD] <br /> Kasey Foley,REHS <br /> ,*Fo Website: www.sjgov.org/ehd Linda Turkatte,REHS <br /> Phone: (209)468-3420 Rodney Estrada,REHS <br /> Fax: (209)468-3433 Adrienne Ellsaesser,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: Applied Aerospace Structures Corporation Telephone: (209) 983-3331 <br /> Business Site Address: 3437 S. Airport Way, Stockton, Ca., 95206 <br /> Mailing Address(if different from above): P0 BOX 6189, StoCkton. Ca., 95206 <br /> Business Owner(s) Name: ATp);x_4 1r"a-,0LLg= 5-kychK-; earl Telephone: <br /> Business Owner Address: 3,437 5. Wow <br /> Nature of Business: "AA ­EfA�o �ce_Fire District: 15:>bU-C7vq -# ko;)-- <br /> al. )<Yes o 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 /> ,KYes c No Does your business generate,treat, or store a hazardous waste in any quantity?(used oil, <br /> used 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. IKYes o No Does your business handle a hazardous material, or a mixture containing a hazardous <br /> 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? <br /> If"Yes", check any of the following conditions that apply to your business: <br /> u 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 /> 08. This business operates a farm for purposes of cultivating the soil, raising or harvesting an <br /> agricultural or horticultural commodity. <br /> Q3. KYes o No Does your business handle an Acutely Hazardous Material? See definition on page 2. <br /> Q4. c Yes Wo 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 disclosur survey is <br /> true and accurate to the best of <br /> my knowledge. <br /> 411111111, <br /> Owner or Authorized Agent: 3 <br /> Pint Name: I-ON K9`TlT'4A-"4- Date: <br /> Signatur -Title: <br />