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E <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhad Averue. Suite 3-- <br /> ':a: Stockio 1, CaHiornia 952-2 <br /> resat <br /> Teieohone (209) 953-6200 <br /> Fax (209) 553-6266 <br /> HAZARDCUS MAT-=PIALS DfSCLOSURsE SURVEY <br /> Please read the information on the reverse side before cornplefirg tHs survey form. A s_parate surveys for each business <br /> name and/or address in San Joaquin Count} is required. <br /> busincss-NaFn-,: Acquiesce Vineyard, LLC <br /> Business Ov:,ner(.$) ,dame: -William R. &Susan L Tipton Telephone: 209-333-6102 <br /> Business.kddress: 22275 N.Trethewa Rd.., Acampo, CA 95220 <br /> ;:tailing Arid:ess (i`different `rorn at)cvey - <br /> Feature of Business: Winery f=ire District: <br /> Cr 1 ©Yes i&Ido Does your business handle a hazardous maleriFf in arty quenlity at env one:lin? ir-the year? See th_ <br /> definilicn of liazardous material on the back of this fe-rrr- i= Your ansiver is No;' gO to QUes_ion u. <br /> �r2 DYPf� Kflc Does your business handle a hazardous rna# riaf,or a mixture containing a hazaidoas material in a <br /> quantity eo±ual to or creator'han 55 gallons, 500 pounds, or 20;3cubie teet 3; any ane iirrie in the year? <br /> If "Yes."how fon0 i ave you handleo'tl"rEfie, fnat-rials at your bud; ess?-- <br /> If "Yes,"vhe K anyoi the-olfov.ing conGit!ons that app4esw i€; \,our buSiT)ecs. <br /> Clr`'. The il10.7a OPUS Ma*iC''r1aiS handle•.^_' Dy't'is business is cOniainec solely in a c4)--S-U lei :roduck, <br /> packaged for direct dis.triL-,ulion tc a io use by, the ceneral pubfic <br /> DD. This business is a hoards care facility (doctor. den;isi, veterinary, et-,-j and ;aces 0:11y medical gases. <br /> DC; Th!= business opelaies a farm. foo" i;UrJ7SE S iii Cr!ittVrltii]Q i:I'I?suEl..iarb'11�, ortia;i«_'5,1i?g ar <br /> aa-icul urai or h:�rtlCLilt ural commodity. <br /> Civ'. Dyes 6% DDes,your b:asiness handie an acute[V hazardous rnnterial? Src definition rr e:crse side a #Itis form. <br /> 04. OYes tNo is your bLJSi1PSS V ilhin 1.000 feet of the outer bcpunda-v o-1 a school (grades K-12"? <br /> I have read the mtofma#ion on this 7atm and undevstand rn),req's;rements 'ander Chap ei 6.9C-of _l-,e Calif;}r,ra HE;alth and <br /> Safetv Code. I unrierstand that if 1 o i',,n a iaciiily or properly that is used by tenants. that it rs .T.y r es:10nsibilltyto nl:,tity the <br /> trenanis of the reoutrements which mus', be rriet prior luissuance ut a Certificate c`Occupancy o-ceginnina of operailors. I <br /> declare :!nde!the Denalty of pe,"jury that.tree inioimabon provided Gni 'his disclosure survev is true and accUrate 1c the best <br /> rf my knt'wledge. <br /> Qv ner c, A.jlhor;zed Acenl- <br /> X_--- William R. Tipton <br /> E,i !t plan -- <br /> X _ -itle: owner <br /> Signa_ure _— <br /> P a g l- E.'D 9 <br />