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4 QUALITY r AIR MANAGEMENT Q CV'T DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396 2000
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AIR Q►UA1 IT'Y PERMIT CHECKLIST �
" for nonresidential buildings only. ,.
Company Name: N u
f Location of Property; 1
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Zip Code:
Contact•Person: SNSN/D'I Pig k-1 Title:N
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Telephone Number: C�/y� g(pD J66r Fax Number: s
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Type of In dustryBusiness: '�v6"'�F�
To apply for a nonresidential building permit, you must complete this checklist. If you have any Y ,
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questions about completing this checklist, please call (800) 388 2121 "
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YES N^U'i
l 1. Will the facility have a,eharbroiler?
2: Will any internal combustion engine with greater than 50. horsepower % of
operate at the facility (excluding motor•vehicles)?
_t 3. Will operations at the facility "
P ty involve mixing, Mending, or processing of
r solvents, adhesives, paints or coatings?
5 4Z Will dust or smoke be generated at the facility?
" 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? Jt
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7. Will any, combusion equipment rated ggreater than 2,OQ0t,00013TU/hr be'
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i operated at the facility?s,
8. Will any acids, solvents, or motor fuel be used or stored at the facility? [� [-- "
.Will any organic liquids` or gases be reacted or produced?
c) G' 10. Will any; ovens be used to dry;or cure products at the"facility?
11. Will any CFC (Freon) recycling;machines operate at the facility9 i
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Applicant: Signature: Signature: -1
� (Print name clearly)
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` If you have marked "NO" in ll the boxes anair quality permit is ` q ty P not needed at this time, i+
F r and this checklist is your written release.
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If you marked "YES" in any of the boxes,
> ,you mush contact the South Coast Air Quality
` a Management L'isiiict,.(AQMd?3. Please read the requirements on the back of checklist.
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i (800) 388-2121 3
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