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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue, Suite 3-- <br /> Q: <br /> Stockton, California 95202 <br /> Telephone(209) 953-6200 <br /> Fax(209)953-6268 <br /> HAZARDOUS MATERIALS DISCLOSURE SURVEY <br /> Please read the information on the reverse side before completing this survey form. A separate survey for each business <br /> name and/or address in San Joaquin County is required. <br /> I <br /> Business Name: Sun Harvest Inc. <br /> Business Owner(s)Name: -Robert Maragliano Telephone: 800-791-2212 <br /> Business Address: 1123 N. Jack Tone Rd., Stockton, CA 95215 <br /> Mailing Address(if different from above): P.O. Box 141, Linden,CA 95236 <br /> Nature of Business: Farming,Custom Farming Fire District: Linden-Peters <br /> Q1. []Yes �v Does your business handle a hazardous material in any quantity at any one time in the year? See the <br /> l definition of hazardous material on the back of this form. If your answer is No,"go to Question 4. <br /> Q2. DYes II Does your business handle a hazardous material,or a mixture containing a hazardous material in a <br /> quantity equal to or greater than 55 gallons, 500 pounds,or 200cubic feet at 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 applies to your business. <br /> DA. The hazardous materials handled by this business is contained solely in a consumer product, <br /> packaged for direct distribution to, and use by,the general public. <br /> DB. This business is a health care facility(doctor, dentist, veterinary, etc.)and uses only medical gases. <br /> DC. This business operates a farm for purposes of cultivating the soll, raising,or harvesting an <br /> agricultural or horticultural commodity. <br /> 03. ❑Yes o Does your business handle an acutely hazardous material? See definition on reverse side of this form. <br /> L <br /> 04. DYes(tiy/ Is your business within 1,000 feet of the outer boundary of a school(grades K-12)? <br /> have read the information on this form and understand my requirements under Chapter 6.95 of the California Health and <br /> Safety Code. I understand that if I own a facility or property that is used by tenants, that 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 <br /> of my knowledge. <br /> Owner or Authorized Agent: <br /> X . _ Date: <br /> Pri_r Name <br /> X�, r --- Title: `�✓l <br /> Signaty� <br /> F:tDEVSVC1Planning Application FormslSite Approval.(Revised 02-03.10) Page 6 of 9 <br />