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PgUinr .CpG 2` s SAN JOAQUIN COUNTY 0D: ` OFFICE OF EMERGENCY SERVICES a17rt ng113id o`q ,SSP HAZARDOUS MATERIALS DISCLOSURE SURVEY 0 Ci 6 PLEASE PRINT OR TYPE 01. Please provide'a separate survey for each business name and/or address in San Joaquin County: a. Business Name: Spreckels Land Company, Inc. b. Business Owner(s) Name: Spreckels Land Company, Inc. Phone: (209) 823-3121 C. Facility Address: Farm location -Austin Road, Manteca d. Mailing Address: P.O. Box 1287, Manteca, CA 95336 e. Nature of Business: Landowner Fire District:Ripon Consolidated f. Business Lic. No: N/A Expires (MojYr) Standard Indstrl Code No: g. Proposed Project: Land grading, excavation ar,' rlaterial export. h. If the business is not in operation, when is the approximate date of operation? 02. Does your business handle a hazardous material? 'Hazardous Material' means any material that, because of its quantity, concentration, or physical or chemical characteristics, poses a significant present or potential hazard to human he�lth and safety or to the environment if released into the workplace or the environment. (Includes fuels, petroleum products, paints, propane, oxygen, ammonia (AHM), chlorine (AHM), pesticides, fertilizers, and hazardous wastes...). Yes ❑ No 0 03. If you answered 'YES' to Question 2 above: Do you handle a hazardous material or a mixture containing a hazard us material in a quantity equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet at any one time? Yes ❑ No ❑ 04. Will the owner, applicant, or future building occupant handle an Acutely Hazardous Material? (List of Acutely Hazardous Materials available at the Planning Department). Yes ❑ No ❑ Q5. Will proposed building or modified facility be within 1,000 feet of the outer boundary of a school (grades K-12)? Yes ❑ No ❑ I have read the Hazardous Materials Information Guide (on back page) and understand my requirements under Chapter 6.95 of the California Health and Safety Code Sections 25505, 25533, and 25534. 1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. I declare under the penalty of perjury that this disclosure survey is true and accurate to the best of my knowledge and is made in the City of California. Owner or Authorized Agent: (Print) / B T �� /C b /�/ Title (Signature) z � � �- Date v � i 1. San Joaquin Valley Unified Air Pollution Control Dist. 2. Office of Emergency Services North Region Office Hazardous Materials Division 4230 Kiernan Ave., Suite 130 222 E. Weber Ave., Courthouse-Room 610 Modesto, CA 95356 (209) 545-7000 Stockton, CA 95202 (209) 468-3969 24-Hour Telephone: 1-800-281-7003 Fax: (209)-545-8652 OES INSP _ DATE APPROVE REJECT _ VERIFIED _ HMMP _ RMPP — EXEMPT_ V.5.12/92