HomeMy WebLinkAbout1 Main St - CofOSUPPLEMENTAL. INiFORMATION
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1.
BUSINESS ADDRESS one Main Street, HuntingtonBeach, CA 92648'.
2.
Person' to contact in case of emergency�nug �'���,a,;h oz Rauh KoS►n�a���'
Telephone number: 714) 644-789C)
3.
Does the building in question have electricity?
IN'Yes
No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
4.
The building is sprinklered?
Yes
El. No
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5.
Operations will produce dust/wood shavings or similar
material
lil' No'
6.
Operations will involve '.the repair or replacement of
❑ Y
;
automobile parts?
M No
If Yes:
(a) Describe the components repaired or replaced.
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(b) Does the operation involve the use of an open flame?
No:
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7.
The lousiness is - drinking, dining or assembly use that. will .
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result:- in an occupant ' load of more - than 50 persons.
'Yes
❑ No
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8.
The following best describes my operation;
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4,
Office Only
,
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product).
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Restaurant / Take Out Food
Medical / Dental
Other (describe) Take out and nining 'AY
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SUPPLEMENTAL INFORMATION
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SUPPLEMENTAL INFORMATION (Continued)
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Does
the operation involve any of the following, materials?
Yes
❑ No
If
Yes, indicate quantities:
Material Quantity
1.
Flammable liquids
Class I-A
Class 1-R
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;Class l-C
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2.
Combustible -liquids
Class 11
Class 111--A
3.
Combination flammable liquids
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4.
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Flammable gases AAA r&A A L MOM.,
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LYquefied flammable gases
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Flammable fibers - loose
7. -
Flammable fibers - baled
8.
Flammable solids
9.
Unstable materials
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10.
Corrosive liquids
11.
Oxidizing material - gases
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12.
- Oxidizing material - liquids
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13.
Oxidizing, material - solids
14.
Organic peroxides
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Nitromethane (unstablematerials)
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16.
Ammonium nitrate
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17.
Ammonium nitrate compound mixtures-
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containing more than 60% nitrate
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by weight
18.
Highly toxic material and
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poisonous ;gas
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19.
Smokeless powder _
20.
Black sporting powder
I hereby certify that the above information is true and correct
to,
the best of my,, knowledge.
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Signature Date
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SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
Location of Subject Property:_:_4ne-ma;n street Hmungtoo- ch. CA
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Properly Owner Name: ripg-of_mihtingtnn Reach Phone #:_(714) 536-5431
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Name of the person preparing this form in print and signature:
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'• _. Signature;_
taR 4sa`.3�NER
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The person preparing this form must be the same persc, applying for building permits. Please answer the
following questions regarding your proposed occupancy of the subject building, IF YOU DO NOT KNOW
I THE ANSWER TO A QUESTION, MARK IN THE "YES" COLUMN:
AQMD PERMITTING CHECKLIST
I' YES NO
1. Does your facility use any internal combustion engines greater than 50HP?'
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2. Does your facility involve mixing, Mending, or processing any soivents,
adhesives, paints or coatings?
3. Does your facility create a" dusts or smoke?
4. Does your facility refine any liquids or solids or reclaim any metals? _
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5. Does your facility plate or coat anything? _
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6. Does your facility have any combustion equipment (i.e. boiler, furnaces,
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broiler, baking ovens, etc.) rating greater than 2,000,000 BTU/HR?
7. Does your facility handle or store solvents or motor f )el?
G S. Do you use or store any acids?
9 Do you use any chemical process?
10. Do you use any solvents for. clean-up? _
11, Are you a dry cleaner, restaurant with a charbroiier, body shop, gasoline
'
station, printer, br part coater?
12. Is the subject building located within one thousand`(1,000) feet of any
school? PROPERTY LINE TO PROPERTY LINE. GRADES K-12.
If you have marked "NO" in all column, you do not need an Air Quality permit at this time. If you have marked
any questions in the "YES" column you must contact the South Coast Air Quality Management District located at:
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
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Please call: Plan Check (909) 396-2000
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