HomeMy WebLinkAbout15162 Triton Ln - CofO (3)n
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SUPPLEMENTAL INFORMATION"
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1.
BUSINESS ADDRESS,
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2.
Person to contact in case of emergency`
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Telephone number:
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3.
Does the -building in question have electricity?
'`
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ , No
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4.
The bui!ding ` is' sprinklered?
Yes
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❑ .No
5.
Operations will produce dust/wood shavings' or similar
material?
❑ ,Yes
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6. -
Operations will involve the repair or replacement of
Yes`
automobile parts? '
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If Yes:
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(a) Describe the, components repaired or replaced.
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O Does the operation ` involve the use of an open
flame?'. ❑ Yes
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❑, No
7.
The business is` drinking', dining or assembly, ,use that
will.
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result in an occupant load of more. than .'50 ; persons.
❑Yes
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D No'
8.
The following best ' describes my ope 'ation,
Office Only
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Retail Sales
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Warehouse
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Manufacturing / Distribution (describe process and end product)
Restaurant / Take Out Food
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Medical / Dental:,
Other (descj-ibe)
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SUPPLEMENTAL INFORMATION
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SUPPLEMENTAL
- IIidFORMATION5, (Continued)
Does the operation involve any .of the
following materials? ,
"L Yes
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❑ No
If Yes,. indicate quantities:-
Material.-
Quantity;
1. Flammable liquids
Class I -A
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Class I-C
2. Combusti, 'e liquids
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Class 11
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Class Ili -A
3. Combination flammable -liquids:.
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Fla'mmabie gases
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5. Liquefied flammable ` gases
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6. flammable fibers- loose
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7. "Flarnmable fibers - baled
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8. Flammable solids
9. Unstable materials;
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10. Corrosive liquids
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11: Gxidi�ing material gases
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12. '- -Oxidizing material- liquids -
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13.' : "Qxidizipg, ,material, -solids.
14. • :' Organic peroxides
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15.; Nitromethane (unstable materials)
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16. Ammonium nitrate
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1T Ammonium nitrate compound ' mixtures
containing more than fQ% nitrate
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by weight
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18. Highly tonic material and
poisonous gas
19. Smokeless powder.
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20. Black sporting powder
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I _hereby certify ''that the,,,'abowe .information 'is 'true „and,t,.correct
to
the best of my knowledge.
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Signature
Date
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47,
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