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•f f In <br /> Y Y: <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Room 610, Courthouse <br /> ` 222 East Weber Avenue <br /> Stockton, California 95202 <br /> Telephone (209) 468-3962 <br /> Hazardous Materials Division (209)468-3969 <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 /> Business Name: Corto assi Partners, L.P. <br /> Business Owner(s)Name: CortQpassi Partners L.P. Telephone: (209) 334-3424 <br /> Business Address, 11292 N. AlRine Road Stockton CA 95212 <br /> Mailing Address(if different from above): <br /> Nature of Business: Olive Oil ProcessinF. Fire District: Mokelumne <br /> Q1. iYes No Does your business handle a hazardous material in any quantity at any one time in the year? See the <br /> definition of hazardous material on the back of this form. If your answer is No,"go to Question 4. <br /> (See Attachment) <br /> Q2. ❑Yes)]No 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 /> I <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 /> l <br /> ❑A. 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 /> ❑B. This business is a health care facility(doctor, dentist, veterinary, etc.)and uses only medical gases. <br /> ❑C. This business operates a farm m for purposes of cultivating the soil, raising, or harvesting an <br /> agricultural or horticultural commodity. <br /> (See Attachment) <br /> 7Yes ❑No Does your business handle an acutely hazardous material? See definition on reverse side of this form. <br /> (See Attachment) , <br /> Q4. 13 es JpNo Is your business within 1,000 feet of the outer boundary of a school (grades K-12)? <br /> i I 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. <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 Authorizeed Agent: <br /> X `)dry t.D 440. L ie-wL-- Date: 5?1*2S,/2-0o S— <br /> Pri <br /> X f Title: �- O c f- sa n �pMfi YY►t <br /> Signature r <br /> FADEVSVOPianning Application FormslUse Permit.(Revised 6-03-04) Page 6 of 9 <br />