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HomeMy WebLinkAbout15070 Edwards St - CofO (15)6 SUPPLEMENTAL iNFORMATION 1. BUSINESS ADDRESS��� '��-���+ �'• _fr�Zr�� 2. Person to contact in case of emergency Telep"nne number: / �`i ' -7-6 3. Does the building in question have electricity? ©'/Yes ❑ No (a) If No, are you requesting that the electricity be G Yes turned on? ❑ No 4. The building is sprinklered? ❑ Yes C'No 5. Operations will produce dust/wood shavings or similar material? ❑ Yes LAN o 6. Operations will involve the repair or replacement of ❑ Yes automobile parts? M No If Yes: (a) Describe the components repaired or replaced. (b) Does the operation involve the u6e of an open flame? ('Yes ❑ No 7. The business Is drinking, dining or assembly use that will result in an occupant load of more than 50 persons. [''Yes ❑ No 8. The following best describes my operation; Office Only Retail Sales Warehouse Manufacturing / Distribution (describe process and end product) estaurant zfce-4t�t---Feed- .� Medica, / Dental Other (describe). iSPPIC=WNTAL WOPNIAMN SUPPLEMENTAL INFORMATION (Continued) Does the oper,*ition invulve any of the following materials? If s, ii,dicale quantities: Material 1. Flammable, - liquids DaF '-A -I C ------ 2. Combustible liquids Class 11 Class ass I I I -A 3. Combination flammable liquids 6. mrnable fibers loose 7. FTWrTT baled 8. Flammable solid:;; nstab!Fa materials 19. corrosive i , qu s Quantity 0 Yes M-No 11. Oxidizing material - gases 'Ti. dx-I j I z 1r, g material - 'liquids 13. Oxidizing material solids 14 Organic p ero xidos it r 1 110 on e n (u otablu watonaj�r;) 16. nimovium nitrate 17. Ammonium nitrim7 f.oi,,ipuijnd mixturG,,,, containing nitro than totr;ito by weight 8. Highiy toxic rnakllifl WId poisonous gas Smoke ,ie,ss- powder , B,iac-k- sp,or,tio(-, powder I herobv certify th, t MCI above the bit of n wl(,-09(,. ?"y ignatur#� inforniabon is true and correct to /a t !7 - , , 1— " t South Coast AIR QUALITY MANAGEMENT DISTRICT 21865 E. Copley Drive, Diamond Ear, CA 91765.4182 (909) 396.2000 AIR QUALITY PERMIT CHECKLIST for nonresidential buildings only Company Name: �',�G/G, o ;^i P .��c Z r,�7.a✓,y11z%7" Location of Property: 11V `!' City: //,,9. _ Zip Code; 9 Contact Person:. JAI /'` ��-mow Title: AleW. _ Telephone Number: %'/ a " `'�/ % _Fax Number; Type of Industry/Busirress: l e,-Oz 1 _r Tu apply for a nonresidential building permit, you must complete this checklist, If you have any questions about completing this checklist, please call (800) 388.2121. YES NO 1. Will ffie facility have a charbroiler? [c� 2. W;11 any internal combustion engine � +ux greater than 50 horsepower operate at the facility (excluding motor vehicles)? [ ] [v] 3. Will operations at the facility involve mixing, blending, or processing of olvents, adhesives, paints or coatings? 4. Will dust or smoke be generated at the facility'? [ ] [ y 5. Will refining of any liquids or solids be done at the facility? [ ] [✓] 6. Will any plating or coating of :materials be done at the facility? 7. Will any combustion equipment rated greater than 2,000,00013TU'/hr be operated at the facility? 8. Will any acids, solvents, or motor fuel be useu or stored at the facility? 9. Will any organic liquids or gases be reacted or produced? 10. Will any ovens be used to dry or cure p.oducts at the facility? 11, Will ,.my C1:C (Freon) recycling machines operate at the fility? Applicant:yz�c"'°A�"� (Print name clearly) !t. If you have marked "NO" in gL,1, the bcxes, an air quJity permit is = needed at this time, and this checlist is your written release. If you marked "YES" in any of the boxes, you must contact the South Coast Air Quality Management District (AQMD). Please read the requirements on the back of the checklist. (800) 388-2I21 ` Anr)1 hIf, r a"I,- a t n" `t'14'11 tpl9"f1l3P�((1ilfz^� a ONW*4w P; [v _jaIL 140ft A" 0 T-T � 4 i t i snwr !t lriK��han pnw'o� A•eaw• fMI NWhi IJ A tf W.v��tL. Ab mI^� t I r!►atlM A WO Net. M. t& ft""" PUwY �Ci V+1 IW.�3i Mf7a. ewwr w� a+u ►u.. w a'in�+ KIMW.N UrY� r�hsrb fR1' u••mNu+lrFf��r) (M MMl v ,a��►�t rkNN+r� w rGOI R'K hN f Rw�'N�19D T� I;f AWE` r1U'�It n'_ F IL wwosom / w .• � � � w � � / | SIZ�\ 8 � ^ S � . . ~rn �\�� . zz ° 7 \ to \ ) Q e ¥ 2 2 // / ?/ r . , IV § / m Lo § 4 . e, ®�/Z / ] . ° 7 \ m-M . f o NJ . � a e \ . A � . ^ ¢ \ � / • I