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20 ®07 5 <br /> S A N J O A Q U I N Environmental Health Department <br /> COUNTY -- <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: Garcia Grow Co. LLC Telephone: 2099865601 <br /> Business Site Address: 407 N. Alpine Rd., Stockton Ca 95215 <br /> Mailing Address(if different from above): 1231 W Robinhood Dr, Stockton CA 95207 <br /> Business Owner(s)Name: Justin Garcia Telephone: 4152541975 <br /> Business Owner Address: 115 Gateway Rd E, Napa, CA 94558 <br /> Nature of Business: Cannabis Cultivation Fire District: East Side <br /> Q1. o Yes c No Does your business handle a hazardous material in any quantity at any one time in the year? <br /> See the definition of hazardous material on page 2 of this form. <br /> o Yes No Does your business generate,treat,or store a hazardous waste in any quantity?(used oil,used <br /> 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. ❑Yes m No Does your business handle a hazardous material,or a mixture containing a hazardous material, <br /> in a quantity equal to or greater than 55 gallons, 500 pounds,or 200 cubic feet at any one time <br /> 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 /> Ei A. The hazardous materials handled by this business are contained solely in a consumer product <br /> packaged for direct distribution to and use by the general public. <br /> o B. This business operates a farm for purposes of cultivating the soil, raising or harvesting an <br /> agricultural or horticultural commodity. <br /> Q3. m Yes e No Does your business handle an Acutely Hazardous Material? See definition on page 2. <br /> Q4. D Yes No 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 Safety <br /> Code(HSC). I understand that if I own a facility or property that is used by tenants, it is my responsibility to notify the tenants of the <br /> requirements which must be met prior to issuance of a Certificate of Occupancy or beginning of operations. 1 declare under the <br /> penalty of perjury that the information provided on this disclosure sunvey is true and accurate to the best of my knowledge. <br /> If you answered"Yes"to Question 2,please go online to cers.calepa.ca.gov to submit your hazardous materials information. <br /> Owner or Authorized Agent: <br /> Print Name: Justin Garcia Date: 3/4/22 <br /> Signature: ,:. Title Owner/Manager <br /> 136,3 E Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 wn iv%,v.sjcehd.com <br />