HomeMy WebLinkAbout15052 Springdale St - CofO (19)r
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SUPPLEMENTAL INFORMATION
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1.
BUSINESS ADDRESS
2.
Person to contact in case of emergency- 01R f�t��J�J 'F 3'(0 -2��p?
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Telephone number: -
,
3.
Does the building in question have electricity?
itd Yes'
L3 No
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(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No -
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4.-
The building is sprinklered?
❑s
No
5.
Operations will produce dust J wood shavings or similar
material ?
❑ yeS
UT No
6.
Operations will involve the repair or replacement of
❑ Y s
a
automobile parts?
190
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame?
0,)Ies
i
I5 No
7.
The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
❑ Yes
"o
8.
The following best describes my operation;
Office Only
Retail Sales
Warehouse
Manufacturing/ Distribution(describe process and end product)
1
Res etut Food
edical J Gen
escribe)
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SUPPLEMENTAL INFORMATION
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1.
SUPPLEMENTAL INFORMATION (ContinuFd)
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Does the operation involve any of the following materials? VN'(0
If
Yes, indicate quantities:
Material Quantity
1. _
FlammaFle liquids
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Class I -A
Class I-B
Class I-C -
�
2.
Combustible liquids
j
Class 11
Class 111-A
3.
Combination flammable liquids
4.
Flammable gases
5.
L.iquefied flammable gases
`
6.
Flammable fibers - loose i
7.
Flammable fibers - baled
8.
Flammable solids
9.
Unstable ; materials
10.
Corrosive , liquids
11.
Oxidizing material' - gases
12.
Oxidizing material - liquids
13:
Oxidizing material - solids
14.
Organic peroxides
4
15.
Nitromethane (unstable materials)
16
Ammonium nitrate
A
17.
Ammonium nitrate compound Mixtures
containing more than 60% nitrate
k
by weight
18.
Highly toxic material and
poisonous gas
19;
Smokeless powder
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i
20.
A
Black sporting powder
hereby ertify that We above information is true and correct to
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the best f my kno a ge.PM
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Signs y ; at
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South Coast
Air Quality Management District
21865 E. Copley Drive, Diamond Bar, CA 91 i65-4182
(909) 396-3529 • http://tvww.agmd.gov
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Air Quality Permit Checklist
California State Law Code 65850.2 prohibits cities from issuing an occupancy permit without
` clearance from the local air quality agency. This checklist will determine if you need to obtain
clearance from the South Coast Air Quality Management District (AQMD).
Company Name:00 4 L r,4,9'
Property Address:
` ;
City: AIAIAIa4dyl Zip Code:
Contact Person: Title:
f Type of Business: / Al Al lr Telephone:
Applicant (print name) C Signature:
• Will the facility have any of the following Equipment? YES[ ] NO [
Charbroiler
Dry Cleaning Machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal Combustion Engine (greater than 50 EP (excluding motor vehicles)
Boiler/Combustion Equipment (greater' than 2MM BTU/hr. maximum input)
Abrasive Blasting Cabinets/Rooms
r Baghouse/Cartridge-Type Dust ,Filter/Scrubber
lJotor Fuel Storage & Dispensing Equipment
t • Will any of the following operations be perforn,, `? YES[ ] NO [
Application of Paints and Adhesives
j Etching, Plating, Casting or Melting of Metals
Plastic Molding, Extruding or Curing )
Mixing and Blending of Liquids and/or Powders
Storage of Acids, Solvents, Organic Liquids or Fuels
Production of Fumes, Dust, Smoke or Strong Odors
{
hf you answered "NO to bothquestions, this checklist is your clearance from AQMD. If you
answered "YES" to either question, you must contact the AQMD to determine if air quality
permits are required. If permits are needed, AQNM will 'assist you ' in submitting permit
applies?ions) and then provide you with a; clearance letter. If you have any questions, please call
AQND r- 11irnall Business Assistance office at, (800)-CUT-SMOG, and press 41.