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HomeMy WebLinkAbout2774 LOKER AVE W; ; CB961177; Permit07/18/96 16:58 Page 1 of 1 B U I L D I N G P E R M I T .Job Add1."ess: 2774 LOKER AV WEST Suite: Permit Type: INDUSTRIAL TENAMT IMPROVEMENT Parcel No: 209-100-10-00 Lot#: Valuation: ,6,61~ Occupancy Group: Reference#: Description: 99 SF,NEW WALLS,CREATE OFFICE : W/FUME EXHAUS'J: HOOD-SYNTRON Permit No: CB961177 Project No: A9601661 Development No: .... _:--\ .. ,. Construction 'l'yp,&·: NEW .:U.:· ,:··, Status: ISSUED Applied: 06/24/96 Apr/Issue: 07/18/96 Entered By: RMA Appl/Ownr : DESIGN BUILD 619-549-8455 9770 LOKER AV WEST SAN DIEGO CA 92126 CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPIJCATION //7 7 City of Carlsbad Building Department 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 EST.VAL PLANCK~D:;;;;:~r:;t""--~-~1'1""~ 1. PERMIT 1YPE VAIID.BY __ -+---l--=----l-~--,..-hf:.'1---L DATE From List 1 (see back) give code of Permit-Type: ____________ _ For Residential Projects Only: From List 2 (see back) give Code of Structure-Type: ____________________ _ Net Loss/Gain of Dwelling Units __________________ _ . 2. PRClJECf INFORMATION s D 2 Energy Cales D 2 Structural Cales D 2 Soils Report ASSESSO' PARCEL DESCRIPTION OF WORK ~IT~ ~~~~~ NAME (last name first) ADDRESS s. i>kkt~ /1S ff-}y~A~O tJ ZIP CODE DAY TELEPHONE NAME (last name first) ADDRESS DAY TELEPHONE NAME (last name first) CITY /f (} 1. D D D STATE LIC. # on m any manner wner-u1 er c arauon: ere y a 1rm t at a exempt rom e o owmg reason: I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, howeve , the building or i rovement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build r improve for e purpose of sale.). I, as owner of the property, am exc usively con cting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License La ·does no apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursua to th Contractor's Llcense Law). (Sec. 7031.5 Business and Professions e: Any City or County which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, als r g ires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's Llcense w Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, an the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil pen lty of not more than five hundred dollars [$500]). SIGNATIJRE DATE COMPLETE tHis SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? DYES D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? DYES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? DYES D NO IF ANY OF TIIE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY Naf BE TI?SlJED AFTER JULY 1, 1989 UNLE.55 TIIE APPLICANT HAS MET OR IS MEETING TIIE REQUIREMENTS OF TIIE OFFICE OF EMERGENCY SERVICES AND TIIE AIR POLI..UTION OONTROL DISTRICT. 9. WNS"IR0Cl'loN Lf:NDING AGRNC\' I hereby afhrm that there 1s a construcuon lendmg agency for the performance of the work for which this permit 1s issued (Sec 3097(1) C1V1J Code). LENDER'S NAME LENDER'S ADDRESS 10. Ai>P.LlCANI CER11F1CAl10N I cerufy that I have read the apphcauon and state that the above mformauon 1s correct. I agree to comply with all City ordmances and State laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE ro SAVE INDEMNIFY AND KEEP HARMLESS TIIE Cl1Y OF CARISBAD AGAINSf ALI.. LIABIIJTIF.S, JUDGMENTS, cosrs AND EXPENSF.S WHICH MAY IN ANY WAY ACCRUE AGAINSf SAID Cl1Y IN OONSEQUENCE OF TIIE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. YEIJ.OW: Applicant PINK: Finance S E W E R P E R M I T 07/18/96 16:58 Page 1 of i Job Address: 2774 LOKER AV WES? Suite: Permit Type: SEWER -OFFICE/WAREHOUSE Parcel No: 209-100-10-00 Description: 99 SF,NEW WALLS,CREATE OFFICE W/FUME EXHAIST HOOD-SYNTRON Permitee: DESIGN BUILD 619-549-8455 9770 LOKER AV WEST SAN DIEGO CA 92126 \ \ \ CITY OF CARLSBAD Permit No: SE960075 Bldg Planck#: CB961177 ;~·,7 '~7 'i -·1 ·q -__ ,.,:..' ~· I .. .}jj ~ t, {]Oi\J.... ,"_,._·,; .... ~ -..; if.:. C-::;MT Status: ISSUEJS-Ca Applied: 07/01/96 Apr/Issue: 07/18/96 Expired: Prepared By: MAM 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 CITY OF CARLSBAD INSPECTION REQUEST PERMIT# CB961177 FOR 08/13/96 DESCRIPTION: 99 SF,NEW WALLS,CREATE OFFICE W/FUME EXHAUST HOOD-SYNTRON TYPE: ITI JOB ADDRESS: 2774 LOKER AV WEST STE: INSPECTOR AREA TP PLANCK# CB961177 OCC GRP CONSTR. TYPE NEW LOT: APPLICANT: DESIGN BUILD CONTRACTOR: OWNER: REMARKS: MW/PG 493-9544 SPECIAL INSTRUCT: PHONE: 619-542}-8455 PHONE: PHONE: INSPECTOR ----.,F----------- TOTAL TIME: --RELATED PERMITS--PERMIT# SE900141 AS940009 FA940007 CO940051 FAD94006 AS950051 FAD95025 CB960269 SE960075 TYPE swow ASC FALARM COFO FADD ASC FADD ELEC swow STATUS ISSUED ISSUED ISSUED ISSUED ISSUED ISSUED ISSUED ISSUED ISSUED r CD LVL DESCRIPTION ACT COMMENTS ~ M_E _F_i_n_a_l_M_e_c_h_a_n_i_· c_a_1 _______ ~ ~:/12';!!;£'7:4~,f</~ ~ ------------------------------------- ***** INSPECTION HISTORY***** DATE 072296 072296 072296 DESCRIPTION Frame/Steel/Bolting/Welding Rough Electric Rough/Ducts/Dampers ACT INSP AP TP AP TP AP TP COMMENTS WALLS,ROOF DISCONNECTS DUCTS,UNITS@ ROOF EsGil Corporation Professiona{ Pfan !l(eview 'Engineers DATE: 7/17/96 JURISDICTION: Carlsbad PLAN CHECK NO.: 96-1177 PROJECT ADDRESS: 2774 Loker Ave West · PROJECT NAME: Syntron Fume Hoods SET: II D FIRE D PLAN REVIEWER D FILE D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's *********** codes. • The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list has been sent to: • Esgil Corporation staff did not advise the applicant that the plan check has been completed. D Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Date contacted: (by: ) Telephone#: • REMARKS: 1. Note on sheet A-1 of the plans that there quantities of hazardous materials will not exceed the limits in Tables 3D & 3E of the '94 UBC. 2. City is to field verify that the existing disabled access and facilities serving the remodeled area comply with the current standards. By: CHUCK MENDENHALL Esgil Corporation O GA O CM O EJ O GP O PC 7/11/96 Enclosures: trnsmtl.dot 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (619) 560-1468 + Fax (619) 560-1576 (. ,.,J EsGil Corporation Professiona( PCan 'R.f,view 'Engineers DATE: 7 /2/96 JURISDICTION: Carlsbad PLAN CHECK NO.: 96-1177 PROJECT ADDRESS: 2774 Loker Ave West PROJECT NAME: Syntron Fume Hoods SET: I ~~NT ~ OFIRE 0 PLAN REVIEWER D FILE D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's*********** codes. • The remarks below are transmitted herewith for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. • The applicant's copy of the check list has been sent to: Barbara Wharton 639 Bison Ct., El Cajon, CA 92019 • Esgil Corporation staff did not advise the applicant (except by mail) that the plan check has been completed. D Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Date contacted: (by: ) Telephone#: • REMARKS: 1. Do the quantities of hazardous materials exceed the max allowable quantities listed in Tables 3-D &E? If not note this on the plans. If you do exceed the quantities the building will be classified as an H occupancy and must comply with Section 307 of USC 2. In addition to the transfer grill shown _on M-2 provide supply air that provide 15 CFM of outside air per USC 1202.2.1. This applies to the lower floor room with the hood if there is no supply air already. 3. New window adjacent to the door shown on A-3 must be tempered glass 4. The new door must have lever hardware per disabled access requirements. By: CHUCK MENDENHALL Enclosures: Esg ii Corporation O GA O CM O EJ O GP O PC 6/25/96 trnsmtl.dot 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (619) 560-1468 + Fax (619) 560-1576 I VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PREPARED BY: CM BUILDING ADDRESS:2774 Loker Ave West BUILDING OCCUPANCY: B PLAN CHECK NO.: 96-1177 DATE: 7/2/96 TYPE OF CONSTRUCTION: BUILDING PORTION BUILDING AREA VALUATION ESGIL Fee (ft.2) Tl fume hoods Air Conditioning Fire Sprinklers ESGIL FEE D 199 UBC Building Permit Fee 0 199 UBC Plan Check Fee MULTIPLIER ($) Hrly 87.15 X 1 87.15 87.15 D Bldg. Permit Fee by ordinance: $ D Plan Check Fee by ordinance: $ 108.93 Type of Review: • Complete Review D Structural Only D Hourly D Repetitive Fee Applicable D Other: Esgil Plan Review Fee: $ 87.15 Comments: -------------------------------------------------' Fire Services Review: D Complete Review D Suppression System D FireAlarm D Other: Esgil Fire Services Review Fee: $ Comments: Sheet 1 of 1 macvalue.doc 5196 Cit~ of Carlsbad I§ h· 1 i 044 A ht· I •l4·khi, ,t§UI BUILDING PLANCHECK CHECKLIST DATE: 7-/ -f b PLANCHECK NO .. CB 9iR // 7 7 BUILDING ADDRESS: :]_if. *-~t) ~er Aue ~s~ 1',,4 ,, PROJECT DESCRIPTION: 1 Li O p /2ause_ -k? -A 1lc-e ASSESSOR's PARCEL NUMBER:otll9-/00:::t"O EST. VALUE b16 / 5 ENGINEERING DEPARTMENT APPROVAL The item you have submitted for review has been approved. The approval is based on plans, information and/or specifications provided in your submittal; therefore any changes to these items after this date, including field modifications, must be reviewed by this office to insure continued conformance with applicable codes. Please review carefully all comments attached, as failure to comply with instructions in this report can result in suspension of permit to build. D A Right-of-Way permit is required prior to construction of the following improvements: DENIAL Please see the attached report of deficiencies marked with D. Make necessary corrections to plans or specifications for compliance with applicable codes and standards. Submit corrected plans and/or specifications to this office for review. By: __________ Date: ___ _ By:, __________ Date: ___ _ By: __________ Date: ___ _ ATTACHMENTS ENGINEERING DEPT. CONTACT PERSON D Dedication Application D Dedication Checklist D Improvement Application D Improvement Checklist D Future Improvement Agreement D Grading Permit Application D Grading Submittal Checklist D Right of Way Permit Application D Right of Way Permit Submittal Checklist and Information Sheet D Sewer Fee Information Sheet NAM~772~ City of Carlsbad ADDRESS: 2075 Las Palmas Dr., Carlsbad, CA 92009 PHONE: (619) 438-1161, Ext. f-Ji_s A-4 P:\DOCS\CHKLSTIBP0001.FRM REV 04/30/96 2075 Las Palmas Dr.• Carlsbad, CA 92009-1576 • (619) 438-1161 • FAX (619) 438-0894 BUILDING PLANCHECK CHECKLIST SITE PLAN 1 s~2ndv 3rdv [Q D D 1. Provide a fully dimensioned site plan drawn to scale. Show: A. North Arrow D. Property Lines Easements B. Existing & Proposed Structures E. Easements C. Existing Street Improvements F. Right-of-Way Width & Adjacent Streets D 2. Show on site plan: A. Drainage Patterns C. Existing Topography 8. Existing & Proposed Slopes D D D 3. Include note: "Surface water to be directed away from the building foundation at a 2% gradient for no less than 5' or 2/3 the distance to the property line (whichever is less)." [Per 1985 USC 2907(d)5]. On graded sites, the top of any exterior foundation shall extend above the elevation of the street gutter at point of discharge or the inlet of an approved drainage device a minimum of 12 inches plus two percent• (per 1990 USC 2907(d)5.). 4. lncl1:,1de on title sheet A. Site address B. Assessor's Parcel Number C. Legal Description For commercial/industrial buildings and tenant improvement projects, include: Total building square footage with the square footage for each different use, existing sewer -permits showing square footage of different uses (manufacturing, warehouse, office, etc.) previously approved. EXISTING PERMIT NUMBER DESCRIPTION P:\00CS\CHKI..S1\BP0001.FRM Page 1 of 4 1stv 2ndv D D D DD D BUILDING PLANCHECK CHECKLIST DISCRETIONARY APPROVAL COMPLIANCE 3rdv 5. Project does not comply with the following Engineering Conditions of approval for Project No. __________________________ _ Conditions were complied with by: _______ Date: _______ _ DEDICATION REQUIREMENTS 6. Dedication for all street Rights-of-Way adjacent to the building site and any storm drain or utility easements on the building site is required for all new buildings and for remodels with a value at or exceeding $ _______ -pursuant to Code Section 18.40.030. Dedication required as follows: __________________ _ Dedication required. Please have a registered Civil Engineer or Land Surveyor prepare the appropriate legal description together with an 8-1/211 x 11 11 plat map and submit with a title report. All· easement documents must be approved and signed by owner(s) prior to issuance of Buildi_ng Permit. Att~ched please find an application form and submittal checklist for the dedication process. Provide the completed application form and the requirements on the checklist at the time of resubmittal. Dedication completed by _____________ _ Date: ____ _ IMPROVEMENT REQUIREMENTS D D D 7a. All needed public improvements upon and adjacent to the building site must be constructed at time of building construction whenever the value of the construction exceeds $ -pursuant to Code Section 18.40.040. Public improvements required as follows: ______________ _ Please have a registered Civil Engineer prepare appropriate improvement plans and submit them together with the requirements on the attached checkli$t for a separate plancheck process through the Engineering Department. Improvement plans must be approved, appropriate securities posted and fees paid prior to issuance of permit. Attached please find an application form and submittal checklist for the public improvements requirements. Provide the completed application form and the requirements on the checklist at the time of resubmittal. Improvement Plans signed by: ___________ _ Date: __ _ P:\DOCS\CHKLSi\BP0001.FRM Page 2 of 4 1 stv' 2ndv' 3rdv' DD D BUILDING PLANCHECK CHECKLIST 7b. Construction of the public improvements may be deferred pursuant to code Section 18.40. Please submit a recent property title report or current grant deed on the property and processing fee of $ _________ so we may prepare the necessary Future Improvement Agreement. This agreement must be signed, notarized and approved by the City prior to issuance of a Building Permit. Future public improvements required as follows: ___________ _ Improvement Plans signed by: ____________ Date: ____ _ D D D 7c. Enclosed please find your Future Improvement Agreement. Please return signed and notarized Agreement to the Engineering Department. D Future Improvement Agreement completed by: ____________ _ Date: _______ _ 7d. No Public Improvements required. SPECIAL NOTE: Damaged or defective improvements found adjacent to building site must be repaired to the satisfaction of the City Inspector prior to occupancy. GRADING PERMIT REQUIREMENTS - The conditions that invoke the need for a grading permit are found-in Section 11.06.030 of the Municipal Code. · D D D 8a. · inadequate information available on Site Plan to make a determination on grading requirements. Include accurate grading quantities (cut, fill import, export). D D D Sb. Grading Permit required. A_ separate grading plan prepared by a registered Civil Engineer must be Submitted together with the completed application form attached. NOTE: The Grading Permit must be issued and rough grading approval obtained prior to issuance of a Building Permit. Grading Inspector sign off by: _________ Date: ____ _ D 8c. No Grading Permit required. P:\OOCS\CHKI.S1\6P0001.FAM Page 3 of 4 1 stv 2nd,/ 3rd,/ DD D DD D BUILDING PLANCHECK CHECKLIST MISCELLANEOUS PERMITS 9. A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Way and/or private work adjacent to the public Right-of-Way. Types of work include, but are not limited to: street improvements, trees, driveways, tieing into public storm drain, sewer and water utilities. Right-of-Way permit required for ________________ _ A separate Right-of-Way permit issued by the Engineering Department is required for the following: ______________________ _ 10. A SEWER PERMIT is required concurrent with the building permit issuance. The fee is noted in the fees section on the following page. S {? 1 (p 00 7 S 11. INDUSTRIAL WASTE PERMIT is required. Applicant must complete Industrial Waste Permit Application Form and submit for City approval prior to issuance of a Permit. Industrial waste permit accepted by: _______ · Date: ___ _ ENGINEERING DEPARTMENT ENGINEERING REVIEW SECTION FEE CALCULATION WORKSHEET D Estimate based on unconfirmed information from applicant. d_ {) CJ -/ 0 0 -/0 D Calculation based on building plancheck pim~?m~:~ ,, Address: ;).. 71 f lo her A uC? Wes I Bldg. Permit No. c.l.S 9 b J / 7 7 Prepared by: /nlJ. '11 Date: 7/J / 7 I.,., Checked by: _____ Date: _______ _ EDU CALCULATIONS: List types and square footages for all uses. ..;. 180C) tJ 06, -. ~ ~ ..J (JJ/>·" ,1,., ~~ ,-/..!.. SCOD L.o O ~ ?" ~ ---- Types of Use:lt,Jq_,:e./2t}t./Se_ W Sq. Ft;-/l::lnits: qq fa4L. EDU's: ______ _ ~-F/-1c.-e_ 4- Total EDU's: ~ t) ---=-------AD T CALCULATIONS: List types and square footages for all uses. .;i.9J~ 6 Types of Use0 )a re house.. fu Sq. Ft.-;l:lnits: q CJ .e:f 6'J%Q00 AOT's: ____ __: . L1'>/~L, v-. c)ffic..-e_ ., Total AOT's __ .,../ ___ _ i FEES REQUIRED: PUBLIC FACILITIES FEE REQUIRED O YES O NO (See Building Department for amount) WITHIN CFO: DYES (no bridge & thoroughfare fee, D NO reduced Traffic lmpad Fee) p~K-IN-LIEU FEE PARK AREA: ___ _ FEE/UNIT: ___ _ .~AF!=IC IMPACT FEE . ADT's/UNITS: __ l __ ~-BRIDGE AND THOROUGHFARE FEE X X NO. UNITS: __ _ 4-06 FEE/ADT:3- ADT's/UNITS: ____ _ ~LITIES MANAGEMENT FEE X FEE/AOT: ___ _ ZONE: ___ _ _ / SQ.FT.: ~ 5. SEWER FEE X FEE/SQ.FT.: ___ _ PERMIT NS /i: ;t, oo 1 S EDU's: ~ 0 4:: X FEE/EDU:/! er;; BENEFIT AREA: Gz DRAINAGE BASIN: b F EDU's: ~ 0 4---X FEE/EDU: 7 W ~INAGE FEES PLOA. ____ . ACRES: ____ _ ~~R LATERAL ($2,500 DEPOSIT) ~ATER FEE EDU's: • 0 4- X X HIGH ___ /LOW __ _ FEE/AC: __ _ FEE/Eoud-100 =$_t ....... :J~-- =$ 3f~ =$ __ ~"--"'--- =$ -e-- 0 =$ 7~.::- oe::> =$ 3- =$._---'=a""--_-- 0 =$----=----- =$ oO TOTAL OF ABOVE FEES*: $ 0 Q 5 --- *NOTE: Thia calculatlon aheet la NOT a complete Hat of all feea which may be due. Dedications and Improvements may also be required with Building Permits. RFV 01 /04/9!1 ~<D PLANNING DEPARTMENT BUILDING PLAN CHECK REVIEW CHECKLIST Plan Check No. CB t16-(/77 Address 2-77L( lCJJi::!:ILAl!Gr tJ Planner Van Lynch (Name) APN: Phone (619) 438-1161 ext. 4325 ---------------------------- Type of Project and Use: //11 OM 711? Al--7:J:. Zone: ? Jll1 Facilities Management Zone: __ s;;-___ _ CFD {cin1ouill # ___ ·--. _______ _ ~ (If property in, complete SPECIAL TAX CALCULATION WORKSHEET provided by Building Department) Legend ~ Item Complete (g Item Incomplete -Needs your action Environmental Review Required: YES NO J< TYPE ___ _ DATE OF COMPLETION: _______ _ Compliance with conditions of approval? If not, state conditions which require action. Conditions of Approval _____________________ _ · Discretiona'ry Action Required: YES _~ _ NO }>( TYPE ___ _ APPROVAL/RESO. NO. _____ DATE _____ _ PROJECT NO. ____ _ OTHER RELATED CASES: __________________ _ Compliance "Yith conditions or approval? If not, state conditions which require action. Conditions of Approval _____________________ _ ' \ ·- California Coastal Commission Permit Required: YES __ NO~ DATE OF APPROVAL: _____ _ San Diego Coast District, 3111 Camino Del Rio North, Suite 200, San Diego, CA 92108 (619) 521-8036 Compliance with conditions of approval? If not, state conditions which require action. Conditions of Approval _____________________ _ . --·, ..... hJclus,i_onaty t-tousin9 Fee requited: YES ___ -----,--· NO k' _ .. (Effective date ef-lnclusionary Hot,1sing Ordinance -~ay 21, 1993). -\.,\ \1\\ ~ .~~ \V-::i \ \', ~ ·S · · . "\'\-\\ :-~~\> Site Plan: -~ D 1. Provide a fuily dimensioned site· plan drawn to scale. Show: North arrow, property lines, ~asen,ef1ts,. existing and propo_sed ·structures, streets, existing stre·~t-,i itnptovements, ri"ght~9f-way wjqth,,.dim,~p_sioned set!Dacks and existing topographicaf I. . ~ ', ,, ,,.,,._\,,--\·'\<•, . . .--,~ . mes. · -__, · ~ · ' · · -._ .. . .-..,.., ., ' '\ ·. ·\ ..,;;;,_ ,, \ 2. Provide legal description of property, and-assessor's parcel.,nt.1rrber .. ,, m/6 zoning: 1. Setba.c_ks: ·~oy£2. . _ffii:J D · 3. ·-Cl D .. 0, 4. Front:· rnt. Side: Street Side: Rear: Lot Coverage:)'-~. . . Height: P~rking: . ·, Required Shown----------'---- Required -----,-,-----,---· Shown ---,---,.,......,...__,...,..____,..,.- Reqwir.ed . Shown __ ·~~-----~ Required Shown _____ _ :Reqt,.Jired ----------........;....-Shown _____ _ . ,Sp.aces" Required -------'----'----Showh _..._ ____ _ Guest Spaees Reqt.1ired Shown _____ _ · OK TO 1ssuE AND ENTERED APPROVAL 1Nro COMPUTER J !.yp L _ K:\AbMIN\COqNTE,R\PLANCK.FRM' -1-17-96,-. L. 't.-~ City of Carlsbad · 96158 Fire Department • Bureau of Prevention Plan Review: Requirements Category: Building Plan Check Date of Report: . Monday, July a, 1996 Reviewed by: (! , ~cL.__,, Contact Name Barbara Wharton Address 6398 Bison Ct. ------------------ City, State El Cajon CA 92019 Bldg. Dept. No. 96~1111 Planning No. Job Name Syntron -"---------------- Job Address 2774 Loker ------------------Ste. or Bldg. No. ____ _ ~ Approved -The item you have submitted for review has been approved. The approval is based on plans; information and/or specifications provided in your submittal; therefore any changes to these items after this date, including field modifica- tions, must be reviewed by this office to insure continued conformance with applicable codes. Please review carefully all comments attached, as failure to comply with instructions in this report can result in suspension of permit to construct or install improvements. D Disapproved -Please see the attached report of deficiencies. Please make corrections to plans or specifications necessary to indicate compliance with applicable codes and standards. Submit corrected plans and/or specifications to this office for review. For Fire Department Use Only Review 1st __ _ 2nd __ _ 3rd. __ _ Other Agency ID CFD Job#_--'-96-'--'1;__;:_5...:..8 __ File# ___ _ 2560 Orion Way • Carlsbad, California 92008 • (619) 931-2121 _, : ,I •. City of San Diego Building Inspection Department Hazardous Materials Questionnaire Plan File# . PART I: CITY OF SAN DIEGO FIRE DEPARTMENT-HAZARDOUS.MATERIALS tw,ANAGEMENT DIVISION: OCCUPANCY CLASSIFICATION Indicate, by circling the item, whether your business will or did process o'r store any of the following hazardous materials. II any of the items are checked off, applicant must contact the Fire Department-Hazardous Materials Management Division, 1222 First Ave., San Diego, CA 921 O 1 • 4_th Floor • Telephone (619) 236-6883 (except item #15). · 1. Explosives or Blasting Agents 6. Oxidizers @ighly Toxic or Toxic Materials Compressed Gases · 7. Pyrophorics . 12. Radioectives Flammable or Combustible Liquids 8. Unstable (reactive) Materials 13. Corrosives Flammable Solids 9. Water-Reactives 14.Other Health Hazards Organic Peroxides 10. Cryogenics 15. None of Th~se Items PART II: COUNTY OF SAN DIEGO HEALTH DEPARTMENT-HAZARDOUS MATERIALS MANAGEMENT DIVISION: CONTINGENCY PLAN REVIEW II the answer to any cf the questions is yes, applicant must contact the Gounty of San Diego Health Department Hazardous Materials Management Division, 1225 Imperial Avenue, 3rd floor, San Diego, CA 92138. Tel~phone (619) 338-2222 prior to-the issuance of a building permit. OFFICE USE ONLY YES NO (FEE MAY BE REQUIRED) 2. O Will your business dispose of Hazardous Substances or Medical Wastes in any amount? 1.1 D Is your business type listed on the reverse side of this form? · 3. O Will your business store, or handle Hazardous Substances in quantities equal to or greater than 55 gallon7 500 pounds or 200 cubic feet or carclnogens/reprodyctive toxins in any quanti.ty? 4. D 5. D 6 .. D · "$. Will your business use an existing, or install an underground storage tank? jg_ Will your business store, use or handle carcinogens, reproductive toxins, or Acutely Hazardous Materials? O For Demolition Permits Only: Does the building or structure for which this demolition permit is requested contain any friable asbestos? • PART 111: SAN DIEGO AIR POLLUTION CONTROL DISTRICT If the answer to any of the questions is yes, applicant must contact the Air Pollution Control District, 9150 Chesapeake Drive, San Diego, CA 92113. Telephone (619) 694-3307 prior to the Issuance of a bullding permit. YES NO 0 RMPP Exempt Date Initials 0 RMPP Required ----'----Date Initials 0 RMPP Completed ----'----Data Initials 1. 1i( D Will the intended occupant install or use any of the equipment listed on the Listing of Air Pollution Control District Permit Categories, on the reverse side of this form. . 2. 0 (ANSWER ONLY IF THE ANSWER TO QUESTION 1 IS YES.) Will the subject facility be located within 1,000 feet of the outer boundary of a school (J( thru 12) as listed in the current Directory of School and Community College Districts, published by the San Diego County Office of Education and the current California Private School Directory, compiled in accordance with provisions of Education Code Section 33190. 3. D D For Demolition Permits Only: Does the building or structure for which this demolition permit is requested contain any friable asbestos? Briefly Describe Nature of the intended Business Activity: Name of Owner or Authorized Agent: L \f ~ Date: __ (;_· ..... z. __ 4_.__ ...... 1'"'"0 ___ _ DO NOT WAITE BELOW THIS LIN FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: ____________________________ _ BY· Date· . EXEMPT FROM PERMIT REQUIREMENTS APPROVED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY APPROVED FOR OCCUPANCY COUNTYHMMO APCD COUNTYHMMD APCD COUNTYHMMD APCD 1N-31fi1('.l·'i.!\ 0/\l E a 29 I 93 Thomas Bros. Coordinates Page ?Q. B 1 :; HAZARDOUS MATERIALS MANAGEMENT DIVISION SITE MAP .. .. sut:'110 HMMD H ____ _ Business Name SYNTRON BIORESEr.RCR INC Emergency Coordinator _ __!J~a ... ro.ue=.s=-, ..... I .... , e-""eta=------------- Business Address 2774 Loker Avenue West Phone Number· Day 727-0112 _ 24 hr/home 487 3855 CD r__ -~-----~ ·_ ---._· -it <.:---<' ---------------,{1) ----~ ,~ -----I I ------------©r----_.,,~-Jwt " i G> --$---:f;·-:-.-o~ @ ... ~ I I 0-4 I I ,t I I. I I i--t I ©---,' m!l ,_{---ir:'- :l I LUVR:!,ROO'>f ·:, '-"',( -~CEl~-.!i,--\ \ \ t ' . t ti I ,~, ~ ~ ™ I[ B--t-L __ ._ 1 ,. ~;,.oo 11111111 , p·-· " ~ 0 I • f/ • ! .. Ll . V, $_ ·_@ . : I / D • •·. • ,V -~.:::: -~ ----g ------------ DISTRIBUTION: DllS IIM 152 110/911 WIIIH-AETURN TO IIMJ..10 YELLOW BUSINESS f\ETANS ~ .- 21 ~ n + --..G'i . • I \CC/ ,k-- '--'--~ ~ I I 5N1F' ,.,,,,.---- 9--..:J IE) 'lf&?;fN<Y IE)/ " '-I - I--,-_:..._ __ Pl AN l EGENQO _,,,,_ . .., .. , .. : ... , .... 0 8 ~ :::,:c:::.-m:-n l. _,,., .. ., ........ ._.... c-.. ao. A :::"''_,.,..,.,,_r-- lP _ _.N,U,,,LOiC&fa:.. MS _._"'A4,.,..1"~'•'~ CED :::c .... -=.:::::·--I 'i•' .... ________ ,_ :• ... __ ., ___ ...,~ & ,u,c-----oH' £. • .., ... ,, • .....,._ A •"•-u•--. & _____ , IIAZARQOU$ MATERIAi S STORAGE I USE AREA$• ..,.....,. .......... ~ 0 -fr,,.,.fr...-,L""'-,_ "' .. :L~==--=--- <8> • E) :Z~:.!:-...,_ ---4) 9 ~~;::. .._..., __ 43> ® ~~~ <? 0 ;;;.:-_:_- ~ e ::....-::::- 0. e -,~ e e ::.:.-::::· =.: .. :.:rc.o.:,-;., , ____ c.._, __ .._.c, .. i ·1 i C<><Hlty of Sin Diego Dcpa1ln,enl of lluf1h Sorvi,.,. IJ/\1E e r2, 29, 93 ') ... . . ---) Thomas Bros. Coordinates HAZARDOUS MATERIALS MANAGEMENT DIVISION SITE MAP St,-.rtit to HMMD , H ___ --'-- Page 20, BI Business Name SYNTRON BIORESEl\RCH INC Business Address 2774 Loker Avenue West IJIIS 11-.1952 110/911 . t;i--:. ·. W,&f,~ I?~ </!Ji,iJltlff.~ 1Z!t'~,IJ!f¾Hf./'tf~t1& 01S 1 RIOU 1 ION: WIIITE·AETUAN TO IIMIAO YEUOW BUSIUESS ClETAtJS BLOG. F Emergency Coordinator __ _..,J:..sa..,mw.ce;...:s:,,_. ... [,~e::..ce~------------ Phone Number • Day 727-0112 24 hr/home ~ ! j J ,f .I I I : . I k ·H '2--1'\0 f'\Ui.:rlf'l..6-~,w 487 3855 ~------'---I- BLDG. C lPKEH AY,PIUE 21 SITE PLAN 1· = oo·-o· .;n~:!> -rorN.-17THAt11'57 Co11C1ty of Sun Dino? Ucpa1tnu,u1 nf Health Suvi~_.,.... lJJ\ 1 E ~ 29/ 93 Thomas Bros. Coordinates Page 2Q, BJ 0 HAZARDOUS MATERIALS MANAGEMENT DIVISION SITE MAP .'~ 4 ••• Sub, .,i( to HMMO • H ___ ___ Business Name SYNTRON BIORESEARCB INC Emergency Coordinator _ ___;iJ.L-'-'a..um.ue:a..s"'-..._L .... e~ea:------------- Business Address_ 2774 Loker Avenue West COATING ROOM 1200 I -,D,.._()-fJ< W.~·,. W i,;oni,:,, o-P -~.). CULTUR. ROOM f 205 I TT II II II • 11 OFFICE 1202 f 5 Q § Phone Number· Day 727-0112 24 hr/home 487 3855 OFFICE ~ II \ ij II df:,~I I r ,\ YI~~~ l , \./ 7 fr-cf\ ~ aiifr~ k: -fll I [ll / Lin \'/M 1 /1. \ ~-f I f1 . \ L 1 II -!'H--4 I v.:I _. __ -:-1 'I -\ L!J r ·7 1· DISTRIBUTION: WIIIH-RETURN TO IIMMD DlfS IIM 152110/911 YELLOW BUSl~JESS RETANS 1 \ I r 71\ . t ! -~ I 1 -.j/ !L:; . ...... . TT1 I ffi• I I =n=, ,;::;::;: II ,=, ---., I 21 County qf Sin Oieoo Oepertmonl or llulth Servi,.,. r ..-:---. IIAlAll'.JJU'i ~ fl'. p IIU\ 11•1 \~ l'l •ll ....__,,..--·------ ,-') o.,. I I I• IHV[HT2!!!, I U,J HAI~ ~fUIAU mJ1 C51"6t.15H(Nf usu OI tw«CS AS rouO'ltS, ' CMCll(UNS, MP1tOCU:ll~C IOllHS OI HAIM(OJS CIH'MSSCD CASCS IN NfJ QUANTI IY. -1 DltU kAIAll)OOS SUiSfAH:tS OI (CH'Ol.N)S IH QUNfJlll[S COUAl 10 c.l~CATCII ltwf JS CAt.LONS, JOO ro,os OIi 100 [till[ rec, ,., ANY CM flK. 1 Nff ACUICU HAINIOOUS USIA.JU(~ 10 OI ~CAICII IHAH IHRCSUX.D rL,WHIC QUANrlflcs. $(( AtlACl[D lkYCNtotr rmN cmc IA8L[ rot SfOflAC.( t(US ND '"IAROOJS CAIAWIICS. 110t ~IP1E1T1R1o1L18U 1M1 1L1U1B1R1 J1C1A1T1 1Al16,:1 101 ;1 V I I I I ~ ,, JI (111111 10 tWllMlM JHl Af I TIME I I I I lOfAl Y(Mlf HO~T I I· I I I "41TS STOI\AC( CAS Ml. I I I I I I I I I I I I I I I I I I I I I ) HAlAAO CATlOOIUU 104 -CHCCIC i, "1'R>PRIAU - I I I I ·b~)[! I I I I I I I / '¢ I I • P'O~S 2 • C,l,llDNS J • TON'S a • HllllllTEAS ' • Mlllf(JW(S a• cui1c rur ~~~[!] CX>H, D CMCI 1-0C(lf/ D fltl'Rl• lOXI M CDHIC[ US( OHLJI MSOS D I II 124 I.JJ IJt 1)1 "' ,., 142 10 IUM ~ls'o'D'1 1u't1' 'A'i'r' D'f' n I -I I I I I I I I I I I ,, 21 CAS l-0. I , , _;, , , , , , , , , , , , , , , , , , , , , , , , 1 , , , , , , , , I l2'l '6" 2~'-, .ii-WI 1104 10 MAXIM"4 N4T AT I TIH( TOTAL Y[NllY A>O~T I I I I I ~,, , I I I I I Ill 124 mtr.N I 1H'£R'o's'!+'L1 ,, 21 I I I I I I JO '4-'•ltvt #41 AT I TUC I · I I I I TOfAL TIMU 11-0UKT [ I I I ~ '2.] I ' I I I I ~ Ill 114 011S lfM 952110/911 §] I • f'OUHOS 2 • CAllOHS J • TOtfS t • HllllUTf.ftS ' • HllllQWIS I • C\.ll!IC HU HAZAAO 10& U.ITS SToR.-.Cl CAUOOAICS -CH[D( tr Al'froPAIATI -COHIC[ UH OHlYI [] ~ ~ ~ O)Hf o =~~~~ 0 MSDS o I)) 1}4 l)J 1)9 141 142 10 111111111n I I I I I I I I I I I n I I I I I CAS M:J. rr I I I I I I I I I I I I I I I I I I I ) 1?4-'-'6 '4J-!f'' 17 1 • rowos 2 • GAllOHS lfllU ~ ) • lUHS [I] 4 • HllllllfllU ' • HllLIOtAAS t • MIC r~~T IJ) 19 SfORAct· [&'fl) IH HAZAAD 10& CAUOOAIU -CH£()( a, Al'f'R>PRIAT[~ ,o,r1c( llSl 01«.YI wti1 m ooHI O cAAC,M'.lC(H/ Hsos D ~ lL1J · "0>fU-ToXIN IJJ l>t UI IU 10 Countv of·s,,,, Oi,oo 0t"par1n,ent of tl1!1J1h Service, . ~Tt -/2, I °23 I 12 (O,rlf:£ USC CINL YJ £STAii l&MIOI . l ··-H 1_1 _, _· _, _1 _I C ·· 2 l ',.:;._ • ~ • ·~--• ~·= -~ --~-.• _,.:_ .. _, .. j__::~--- ~ N4TDIIALS IIUSUt!SS ftUN p,L.£1.S[ LIST TME IWCE. TITl.UPIOSITICN NC> "<IN£ MM!DtS f0Fflc:£ MD NJ«n•-MU M 1Hf IMOIG£1CT 0CCR:>1Mi\T'Olt NtO At.TDINATES -«> Mt' OU'J.S,IED NC AUnatlUD TO ASSIST OCDUICY JIEJIIONSE P"PtSONNCL (,at DWiPL£. ,11U'. ~> IN T)C( tYOfT OI N4 E>mtCOCY. ,, ~ u 71 CITT 110 ICNIO S1ltEET CITT ll I l I I l/101Jo 1 I lv 11~s 1i½1 iv 1f'L1 1c1E'k~1oi/01II -c-10-1R-10-11J-½1--1 -. -, ---.. 110 ( I I l \ ., 21 _10·~11 1 J If o'u%'ft'A 1-L'r•»'E-1 1 1 1 1 1 1 ) ~¼ X? ·/J~·f~'o• , , 1 1 1 I c---.__ _______________ _ II IJ Ill DHS:HM-952 1101911 20 COl#ltv at San Dleao D-.,.rtment of HNlth S-V,caa ·: ., l ' 'l • OAT£ __ __. ____ _.__ __ Submit to ·HMMD Dunn and Bradstreet· 'H . ---------SIC· Code:_____ HAZARDOUS MATERIALS BUSINESS PLAN Number: ___ _ · II. EMERGENCY RESPONSE PLAN Business Name ,}yJ"rn11 ¥,e,sep.~ ~ Business Site Address 2 77-i Lbc&r weir ,,. fti.rl~bttdj .CA. 1.uxJ3 Business Telephone &(C/-72.!7-Q/('2--24-Hour --3. 4. 5. 6. Notification Procedures: 7. ~\ ~ In the event of a release or threatened release of a hazardous material the following agencies are to be notified: A. 8. Local Emergency Response Agencies Hazardous Materials Management Division State Office of Emergency Services Name of person(s) Phone If 911 338-2222 (911 after working hours) (800) 852-7550 (916) 427-4341 tJ. e ~ .:StVi · t<Vli Describe notification procedures: A :S /csf;d ab¥? _aqj deaf/ -ur (oh [l}.ctr a(Wifrr£,, dr1oud :Jh.c. W-5!7L if 11eeded , Emergency Procedu es: /10.iVI (1nrern :S ~.. Hre,, or -suJJ.e11 rdea.Q';_ < 02- DISTRIBUTION: WHITE-RETURN TO HMMD DHS:HM•952 [10/911 YEU.OW•IIUSINESS I\ETAINS 22 Countv of S... Diaoo Oepanment ot HNI/th Servw:• l, , DATE __ __. ____ _._ __ H ________ _ HAZARDOUS MATERIALS BUSINESS PLAN III. EMPLOYEE TRAINING DESCRIPTION Submit to HMMD Number: ____ _ ~ {he fo 11 owing describes the employee training provided for a 11 employees that handle hazardous substances. l. 2. 3. 4. Training Topic - Persons Trained: hazardous Training Topic -Use of emergency response equipment and materials under the business control: Training Topic -E~ergency Response Plan implementation: 0 OlSTRIBUTION: WHITE-RETU~ TO HMMO OHS:HM-952 110191 I YEU.OW•8USINESS ftIT AINS 23 County of San [);ego O.C.-,ment of HNfth S.rv,cec (, '·· e ' .J IN CASE OF FIRE: 1. Notify other employees to evacuate the building by shouting, "FIRE! ALL EMPLOYEES EVACUATE THE BUILDING!" 2. If possible, extinguish fire using porta- ble fire extinguishers. 3. Notify Vista Fire Department by dialing 911. 4. All employees are to assemble at the staging area located next to the mail box in the parking lot. IN CASE OF SPILL: 1. 2 • 3. ACIDS: Neutralize acid with Sodium Bicar- bonate (:-iaHC03). Soak up neutralized acid using ARG-Dri absorbant pads while wearing proper protective clothing. Wash area with copious amounts of water. BASES: Soak up bases using ARG-Dri absorb- ant pads while wearing proper protective clothing. Wash area with copious amounts of water. PETROLEU:.1 OIL: Soak up small spills with ARG-Dri absorbant pads or absorbant gravel. Clean area with soap and water. For large spills, attempt to prevent oil from enter- ing storm drains using ARG-Dri absorbant dikes and pads. Notify Vista Fire Depart- ment. Call clean-up contractor to remove spill as necessary. ' I SECTION A -HAZARDOUS WASTE GENERATION , : NOTE: If you know that your business generates, stores or handles hazardous wastes, please continuew,th Section B of the questionnaire. All others must complete #1 through #6 that follows. 2. 3. Does your business or service gener.a~e, tore or handle any of the by-products or wastes listed in the box below? YES· NO I I Circle the letters of the cate- gories found at your business. a. halogenated -chloroform, methyl chlorlde o.-: oxygenated -acetone, butanol, ethyl acetate c. hydrocarbons -benzene, hexane, stoddard :A. So I vents d. unspecified solvent mixtures B. Sludges -alum, paint, degreasing; caustic, paper, tetraethyl lead, I lme, tank bottom waste and metal sludge C""i Waste OIi/Mixed OIi -waste motor oil, fu~I tan_k cl_e_anlng re_sl_due, oil separation waste, lube oil "-:/ processing waste o. Pesticides and Pesticide Rinse Water -Parathion, Malathlon, Dlazlnon, and other pesticides; pesticide residue from container rinsing E. PCB -mineral oil contaminated-electrical capacitors, ballasts, and electrlcal transformers F. Monomer/Polymeric Resin Waste -plastic coating and laminating waste, resin coating, metal bind- Ing and coating resin rinse waters G. Blologlcal Waste -Infectious hospital waste, laboratory and pharmaceutical research waste ex- ceeding 100 kg/month H. Organic Liquid/Sol Ids -polymer extrusion waste, PVC coating residue, adhesive waste, organic stripper from semi-conductor processing waste {I;) Contaminated Aqueous Solutions: Iii:\ with reactive an·fons -azlde, bromate, chlorate, cyanide, fluoride, hypochlor- '-J ate, nitrite, perchlorate, sulfide anions, plating rinse solutions, metal coat- ings and metal parts cleaning solutions. b. with heavy metals -Including antimony, arsenic, barium, b~ryllllum, cadmium, chromium, cobalt, copper, lead, mercury, molybdenum, nickel, selenium, sliver, thallum, vanadium and zinc. c. with organic residues -Including degreasing and metal cleaning solutions, equipment cleaning, dry cleaning, antlcorroslon and coolant solution wastes. J. Acid Solutions -wastes battery acid, plating waste, printed circuit etching resldue,slllcon wafer reclamation and cleaning wastes, galvanizing wastes, other acidic solution wastes with pH~ 2. K. Alkal Ina Solutions -wastes from metal plating, anodizing and etching, containing sodium or cal- cium hydroxide, and other solutions with pH~ 12.5 L. Asbestos -Insulation products, old pipe laglng M. Meta I.· SI udges and Dusts -meta I mach In Ing cool ant s I udges, meta I p I ckl Ing s I udges, meta I mach In- lng dusts N. Miscellaneous -chemical toilet waste, photochemical processing waste, laboratory chemical wastes, drllllng mud, S08p and detergent production wastes. Do you dispose of any items in #1 by discharging them into the sewer system including down~~ks, floor drains, toilets, etc.? I YES p-l.. NO l=I If yes, which category(ies) of by-products or wastes? vL Do you dispose of any items listed in #1 in a way_other than disposal into the sewer system (for example, trash cans .dumpster, storm drain, on the ground, evaporation ponds, land fills, etc)? YES · 0 I I If yes, which category(ies) of by- products or wastes? -1/e · Ya. · co· o DHS:HM-9O6 (8/87) County of San Diego Department of Health Services Page 1 SECTION A -HAZARDOUS WASTE.GENERATION (continued), 4. Do you recycle of the items listed in #1 through another company/contractor or by NO D .. If yes, which category( i es) of by-products or wastes? c··., 5. 6. ·yourself YES ,, Do you manifest {prepare the re 1 quired t~ortation document for hazardous wastes) any i terns listed in #1? YES _I NO _y--r-.... If you answered "yes II to ~ of the questions (1, 3, 4, or 5) your business or service does generate hazardous waste and a permit from the San Di ego County Department of Health Services is required. Continue with Section 8 of the questionnaire. PLEASE RETURN THIS SECTION DHS:HM-906 (8/87) Page 2 • I G'l J ,v SECTION B -INVENTORY OF HAZARDOUS MATERIALS A "hazardous substance" is a chemical, compound, or product for which a manufac- turer or producer is regui red by 1 aw to prepare a Materi a 1 Safety Data Sheet· (MSDS) for that substance. An MSDS is a document (usually 2 or 3 pages) which contains chemical composition information, fire and explosive data, health hazard data, reactivity data, spill or leak.procedures, special protection information and special precaution information. An MSDS for a hazardous substance can be obtained from the supplier of that substance. Hazardous substances also include materials requiring placard warnings during transportation. 1. Does your establishment use or handle hazardous substances in quantities equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet of comp.r_zy.ed. 1 gas at any one time? Yes ~o l=I 2. Review the health hazards data or health and safety-section of the Materi- al Safety Data Sheets (MSDS) to see if any chemicals or substances you use are designated as a cancer-causing substance (carcinogen) or substance which may cause birth defects, miscarriages, or damage to the human repro- ductive system (reproductive toxin). Does your ~lishment use or handle carcinogens or reproductive toxins? Yes~ No I I 3. Does your establishment use or handle gases with Threshold Limit Values (TLV) or Time lJ1·ghted Average (TWA) of 10· parts per mi 11 ion or 1 ess? Yes l=I Nor' - If you have answered "Yes" to~ of the above questions (1, 2, or 3), you do use or handle hazardous materials that are subject to inventory requirements and a permit from the San Diego County Department of Health Services is required. Con- tinue with Section C of the questionnaire. SECTION C -UNDERGROUND STORAGE TANKS An "underground storage tank" is a tank, including piping, which holds hazardous wastes (as defined in Section A) or hazardous substances (as defined in Section B, regardless of volume) and has 10% or more of the total volume located below grade. Does your·business·have underground storage tanks as defined above? Yes 1-1 No~ If you answered "yes" a permit from the San Diego County Department of Hea'fth"'- Services is required. Underground storage tanks may not be installed, removed, destroyed, repaired or operated without permits from this Department. Continue with the Hazardous Materials Sunmary on page 4. DHS:HM-906 (8/87) PLEASE RETURN THIS SECTION. County of San Diego Department of Health Services Page 3 < .. HAZARDOUS MATERIALS SUMMARY (''. Complete the following information regarding the handling of hazardous "··., material~ at your business or service.· Check .QTig statement. --r:::£. -~is business or service does generate hazardous waste, handles ·)::::r-~~·i,;ardous materials subject to the inventory requirements and/or has underground storage tanks that requires a permit from the San Diego County Department of Health Services. D I have determined that this business or service does not generate hazardous waste, handle·hazardous materials subject to the inventory requirements or has underground storage tanks requiring permits from the San Diego County .. Department of Health Services. I declare under penalty of perjury that to the best of my knowledge and belief the statements made herein are correct and true. I consent to all necessary inspections allowed by law and incidental to the issuance of required permi an the op ration of this business. Signature -4-,L.~~~=--..i,.,:;~====-------Title k/enerd. M:yr Date Phone 6/9-'72'7 ¥JI/ 2--- Type of Business ,,-/1_,_ed,_;a_~R,_,.___...De..-...lJ ..... iC ..... f-::---,./1_att ..... U ..... ~----t-t. ... n .... lf ________ _ r--Please complete the business information on the reverse of this page and t · return this questionnaire to the San Diego county Department of Heal th services in the pre-addressed return envelope or mail using the :following address. a ~ SAN DIEGO COUNTY DEPARTMENT OF HEALTH SERVICES ENVIRONMENTAL HEALTH SERVICES HAZARDOUS MATERIALS MANAGEMENT DIVISION P.O. BOX 85261 SAN DIEGO, CA 92186-5261 If a San Diego County Hazardous Materials Management Permit is required for your business or service a representative of this Department will complete an inspection of your business. Permit fees will be determined from the inspection and a billing statement will be mailed. NOTE: If you do not use hazardous materials, generate hazardous waste, or have underground storage tanks you are still required to return :tl)is form. A representative of the San Diego County Department of Health services may contact you to verify the information provided on this questionnaire. DHS:HM-906 (Rev. 9/91) -4- county of San Diego Department of Health Services r OFFICE USE ONLY: 1-Upda'te 2-Add I C00£jl I OFi ICE Ost OHt:i: .. ·.· I Fl le Key Number I ____ _ Hi\ZARDOUS MATERIALS NAMGEMENT QUESTIONNAIRE/PEAMIT AWLICATION 2 c::...I _________________ _,, . Please canple'te 'the fol !owing lnfonna'tlon. If lnfor- Mtlon at lef't Is correct, skip to Item #A3. If cor- r~tlons are necessary, also canplete #Al and #A2. A 1. EST ASL I St+IENT NAME ISY',U'T'RIOI,{/ I.BIIIOIRIEI.SIEIAIRlc.1,il. IIl,{)ICI I I I I I I I 7-----------------...... --------------------------------+, ---------------36 A2. MAILING AOCRESS S1REET NLMBER 37 CITY I I I 44 S1REET DIRECTION (N,S,E,W,NE,SW,ETC.) rn I I 4T°4'6 l..:v_1-=I=-1.;;.:S_1_7;.....1A ....... ' __ 1 _1 _-_' ___ 1 _1 _1 _' _1 ~-l 67 81 A3. ESTASLISt+IENT PHONE A4. CONTACT PERSON S1REET NAME CR P.O. BOX NLMBER lJ1 0 16 1M1U1A1 10A1Y1 , 1 1 1 1 I 4·"'!!!7---------------------66 STATE ZIP CODE lc 1AI l1 12 10 1i3l-l ___ l 82 83 84 · 92 BLOG/PLANT t«> I I I I I 1 ____ 1· 93 96 1 z 1 2.1 1 o' , ' , 1.il l"""!,c~, a~1r-"IA!""P"1 R...,1""'."'L--'E~-1-.5~' ..,., ~y-, v..,., _,....,.....,~---......... ---, -.1 97 r ' 103 104 123 A5. ESTABLISt+IENT ADORESS (IF DIFFERENT FRCJ,f MAILING ADORESS) S1REET NLMBER S1REET DIRECTION S1REET NAME b .. '717141 I I I I 7 1-4 CITY 37 A6. O,,NER NAME (N,S,E,W,NE,SW,ETC.> rn I I 1516. I I I I 51 l~L_1_0_1_c_1k __ ~1f_--'R~'-'_w_1E_15_1T_1 _____ 1_1 _1_1_I 17 36 STATE ZIP CODE e·LDGIPLANT t«> lclAl lq 12-10 1 o'?l-1 1 1 1 l 1 ___ 1_1_1 _I 52 53 54 62 63 66 A.7. OlfNER Pt«lNE c:. lk:ll31.LI · 1I'J./'V'El':51Tl/ .. ,(E,ii/Tl_:sl I I -I I .. I 86 I ~·I I I 91 't 2,i 71 0 I p I I 2-i \ 67 AS. NNCE OF PREVIOUS afNER Ito 1R1 D 'Nt<l 1A!:S ~ 101c 11A 'f@-5 1 1 l 97 116 87 96 A.9. DATE YOU STARTED CR ASSLMED BUSINESS MO DAY YR I I I I I I I I 117 122 AlO. REASON FCR APPLICATION A11. TOTAL NlJ48ER OF EMPLOYEES 1"fl 1 • New '? I 71 I I I I 2 • R.-()pen IJ. __ I 7 3 • Change of Owner 8 / 11 A12. DO YOU HAVE PERMITS FCR ANY OF 1l£ FOLLOlflNG: YES AIR POLLUTION CONTROL DISlRICT l=I SEWER DISlRICT (F~ INOUSlRIAL WASTES> l=I HAZARDOUS WASTE FACILITY l=I HAZARDOUS WASTE Ht\ULER REGISTRATION l=I REGIONAL WATER QUALITY CONlROL BOARD ,-, - OFFICE USE ONLY NO ,-1 - •=1 '=' '=' '=' FCR OFFICE USE ONLY I I 121 116 -1 :..:====::.1 171 122 I 231 I --------;:::;:::;::::;:::::;134 I I I I 351 ____ 138 n I I 39 SIC 1 SIC 2 CENSUS TRACT UC BUSINESS EXPIRATION D,\TE COOE COOE ANNUAL FEE MO DAY I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 52 55 56 59 68 74 75 77 78 _. 83 8-4 87 STATUS FIRE WATER SEWER n rn rn rn n I I I I I I ,_, 88 89 91 -93 95 OHS.ltC 906 (7/87> County of San, Diego . -0.par-t11ent of Health Services