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SAN JOAQUIN VALLEY UNIFIED AIR POLLUTION CONTROL DISTRICT <br /> COMPLIANCE QUESTIONNAIRE <br /> 4800 ENTERPRISE WAY,MODESTO,CA 95356 <br /> (209)557-6400•FAX(209)557-6475•asbestos.north@valleyair.org <br /> ATTENTION: FILE/PERMIT NUMBER: <br /> TO BE FILLED OUT BY APPLICANT FOR NEW DEVELOPMENTS OR PROJECTS INVOLVING <br /> DEMOLITION AND/OR RENOVATION <br /> RENNOVATTIIO�N AND SUBMITTED TO THE SJVAPCD OFFICE ABOVE <br /> BUSINESS/PROJECT NAME: `��t"/ [% �`` j TODAY'S DATE: 2'��' <br /> PROJECT SITE ADDRESS: ��' � M{tly Vt I4II <br /> CITY: ,4PI <br /> CONTACT NAME:PK IMV Ge*VAPM PHONE#: iV- *7 <br /> i*(TAX#: <br /> DEVELOPER: P}�HONNEE#: FAX#: <br /> PROJECT DESCRIPTION: Nl{ V�MT�I�{ EMAIL: g� V L C-4 All <br /> NESHAP(Rule 4002-Buildine Demo Iition/Renovation) <br /> 1. Will any load-bearing structure be removed?.......................................................................................................YES[ NOK <br /> 2. Amount of existing building material to be disturbed during this project: <br /> Greater than 260 linear feet of insulated or non-metallic pipe or similar material....................................................YES[ ]NO'p� <br /> Greater than 160 square feet of interior or exterior wall,flooring,ceiling,roofing,ducting or other material..................YES[ ]NO <br /> Greater than 35 cubic feet of other building material debris..............................................................................YES[ ]NO <br /> Indirect Source Review(Rule 9510) (Rules available at ww•w.valleyair.org) <br /> 3. Type of Space To Be Constructed(check all that apply) )�Q Commercial [ ] Residential [ ] Educational [ ] Light Industrial <br /> [ ] Heavy Industrial [ ] Medical Office [ ] General Office <br /> �[y]] Government [ ] Recreational [ ] Other/Unidentified <br /> 4. Square Footage of Building(s)to be Constructed ](tit/ fl KTenant Improvement(TI)to Existing Space Only <br /> 5. Number of Residential Units to be Constructed <br /> Regulation VIII(Rule 8021-Dust Control at Construction and other Earthmoving Sites) <br /> 6. Will 1 or more acres of land be disturbed as part of this project?............................................................................YES[ ]NOK, <br /> 7. Will 2500 cubic yards of material be excavated or relocated per day on any 3 days during the project?..............................YES[ ]NOK <br /> FOR SJVAPCD USE ONLY <br /> [ ] Asbestos/NESHAP requirements satisfied OR in progress <br /> Comments <br /> Regulation Vlll (Dust Control)requirements satisfied OR in progress <br /> Comments <br /> ] Indirect Source Review requirements satisfied OR in progress <br /> Comments <br /> REVIEWED BY: DATE: <br /> Com Questionnaire.doc Revised 6/13/18 <br />