HomeMy WebLinkAbout15240 Transistor Ln - CofO (5)f
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w UPPLEMENTAL INb; O.RMATIORI
1.
BUSINESS ADDRESS
2.
Person' <to cor" ict in case of emergency,
'Telephone number:
3.
Does the building in question have electricity?
[Yes
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No
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(a) if No, are you requesting that the electricitybe
❑ Yes
turned on?
No
yes
4.
The building- is sprinklered?
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No
5.
Operations will produce dust/wood shavings or similar
naterial?
❑Yes
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N o
'
6.
Operations will involve the repair or replacement of
❑Yes :
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automobile parts?
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If Yes:I
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(a) Describe' the components repaired or replaced'.
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flame? Yes
No :
b Does the operation involve the use of an open
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7.
The business is drinking, dining or assembly use that
will
result in an occupant load ,of more than 50 persons.
❑Yes
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EN o
8.
The following best describes my operation;
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`
Office Only f
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arehouse
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Manufacturing / Distribution (describe process and end
product)
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Restaurant/Take Out Food
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Medical / Dental
Other (describe)
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SUPPLEMENTAL INFORMATION,.... _..a ., .,..
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SUPPLEMENTAL
INFORMATION (Continued)
r Does the operation involve any of the
following materials? C1 Yes
-WNo
If
Yes, indicate quantities:
t
Y.
Material
Quantity
1.
Flammable liquids
Class I -A
Class I
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Class I-C
2.
Combustible liquids
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Class II
`
Class Ill -A
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3.
Combination flammable liquids
4.
Flammable gases
5.
Liquefied flammable gases
6.
Flammable fibers - loose
T.
Flammable fibers - baled
8.
Flammable solids
M
9.
Unstable materials, :
10.
Corrosive liquids
11.
Oxidizing material - gases
12.
Oxidizing material liquids
13.
Oxidizing, -material -.solids
14.
Organic peroxides
15.
Nitromethane (unstable materials)
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16—
Ammonium nitrate
17.
Ammonium nitrate compound mixtures
`
containing more than 60% nitrate
h;
by, weight z
18.
Highly toxic material and
poisonous gas
19,
Smokeless powder
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2G.
Black sporting powder
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1. hereby certify that the . above informationis true and correct to
the best of my knowledge.
.
Signature
Date
f ,
x
'.
South Coast
,
AIR QUALITY MANAGEMENT DISTRICT
�
21865 E. Co aey Drive, Diamond Bar, CA 91765-4182 909 396.2000
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AIR QUALITY PERMIT C1CIKLIST
for nonresidential buildings only
Company Name: � _ T� �r \t�1 �-7 1 kQC_U 7 5
Location of Property: /1S�,c� lam/
City: Zip Code: _ 5�i� <l5�1
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Contact Person: Title:
Telephone Number: �l� PiFzl- ZJl 2 Fax Number: --Z/—,/-/j
Type of Industry/Business:
To 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
L Will the facility have a chazbroiler? [ ]
NO • ". q
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2. Will any internal combustion engine with greater than 50 horsepower
operate at the facili t-y (excluding motor vehicles)?
3. Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings? [ ]
4. 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? [ ]
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7. Will any combustion, equipment rated greater than2,000,000 BTU/hr be
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operated at the facility?
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8. Will any acids, solvents, or motor fuel be used or stored at the facility?
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9.. Wills ,y organic liquids or gases be reacted or produced? [ ]
10. Will any ovens be used to dry or cure products at the facility? [ ]
11. Will any CFC(Freon) recycling machines ,operate at the facili
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Applicant: ,lt ' ignature:
u
(Print name clearly)
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If you have marked "NO" in all the boxes, an air quality permit is not needed at this time;
4
and this checklist is your written release.
"
If you marked "YES" in any of the boxes, you must contact the : 4outh Coast Air "Quality
Management District (AQMD). Please read the requirements on the back of the checklist.
(800) 388-2121
. ADDITIONAL SUPPLEMENTAL INFORMATION
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