HomeMy WebLinkAbout058-050-012�n 14
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Env ii-o.nmental, MI
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BUTTE COUNTY ENVIRO?A r RLlk ARTMENT NOV 10 2034
HAZARDOUS MATERIALS AND EMIS.,1 ONSUESTI
Q ONNAIRE
(A BUILDING PERMIT CANNOT BE APPROVED WITHOUT THIS COMPLETED)ALIF (u`�,A
PROJECT ADDRESS I
FIRM NAME °
ADDRESS JI�
NATURE OF BUSINESS
CONTACTPERSON
1.
PHONE
Does your business or that of your tenants handle, store, or transport hazardous materials? NO ( ) YES'N )
NOTE: Hazardous materials are defined as any material that, because of its quantity, concentration, or
physical or chemical characteristics, poses a significant present or potential hazard to human health
and safety or to the environment if released into the workplace or the environment.
"HAZARDOUS MATERIALS" include, but are not limited to: hazardous chemicals, hazardous
waste, paints, oils, lubricants, fuels, flammables, combustibles, corrosives, gases, and any material
which a handler or the administering agency has a reasonable basis for believing to be injurious to
the health and safety of persons or harmful to the environment if released.
2. Do you or will your future tenants handle, store, or transport 55 gallons, 500 pounds, or 200 cubic feet
(at standard temperature or pressure), of formulation containing hazardous material? NO( ) YES �)
If you answer YES to 1 or 2, contact the Butte County Environmental Health Department at (530) 891-2727 for a review
of the project.
3. Is the business/facili /operation to be located within 1,000 feet of the outer boundary of a school or
a school site? NO) YES ( )
IF YES, Name of school:
4. Does the business/facility/operation have the potential to emit any air pollutants: e.g. dust, soot, odor( fumes,
® vapors, or other volatile compounds? NO () YES( )
IF YES, contact the Butte County Air Quality Management District at (530) 891-2882 for permit requirements.
Owner or Authorized Company Representative ` ,� -� Datee40 Mo
BCEHD BCAQMD
❑ The applicant has met or is meeting the applicable requirements of Section 25505,
25533, and 25534 of the Health and Safety Code and the requirements for a permit
from the Butte County Air Quality Management District.
The above regulations DO NOT apply to this facility.
BCEHD Signature
BCAQMD Signatu
Date
Date 11-17—OIL/
03/02 White -Bldg. Div. Yellow-BCEHD Pink-BCAQMD Goldenrod -Fire Dept.