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San Jc _.,uin Valley Air Polh n Control <br /> District <br /> Indirect Source Review (ISR) - Air Impact Assessment (A.Uk) <br /> Residen tia I/Non-Resi den tial/'Mixed-Use Application Form <br /> A. Applicant lniorm7tion <br /> Applicant!Business Name:DeAlabarca Design and Build,Inc <br /> State-CA <br /> Mailin-Address:3901 Brickit Ct City:Ceres Zip:95307 <br /> Contact.,-TJ VanderNleen Title:Project Engineer <br /> Is the Applicant a licensed state contractor? E]No Yes,please provide State License number. 799737 <br /> Phone: 209 480 4484 Fax:209 543 9679 1 Email: tioa dellabarca.riet <br /> B. Agent Information (if applicable): <br /> Agem/Buslness Name: <br /> 1 City:Ceres State: Zip: <br /> Contact: Tide- <br /> Fax: Email: <br /> Phone: <br /> C. Project Information ONION..nommo� <br /> Tract Number(s)(if known): <br /> Project Name: FC Tracy Holdings <br /> P roject Location Street:3890 W.Lehman Road City:Tracy Zip:95377 <br /> Cross Streets:State Highway 33 County:San Joaquin <br /> Permitting Agency:San Joaquin CountY Plann= <br /> City: State: Zip: <br /> Mailing Address: <br /> Permit Type and Number(if known): Subject to Project-Level Discretionary Approval? Yes No <br /> Building Permit Last Project-Level Discretionary Approval Date: <br /> Last Project-Level Ministerial Approval Date: <br /> D. Project Description <br /> Please briefly describe the project(e.g..300 multi family residential units apartments and 35,000 square f�et of commercial uses): <br /> Construct approx. 13-20DO if reffidgerated building for com prmessing. 11200 sf adminiz-aion offict.-_, 16000sf ,,. <br /> ge building. <br /> [Please check the box next to.each applicable land use below: Select land use setting below: <br /> E] Commercial/Retail F-1 Educational El Office 0 Warehouse F-1 Urban 0 Rural <br /> F0 Residential M Govemment Industrial Distribution Center <br /> F-1 Recreational(e.a.park) [J Medical Manufacturing Other <br /> E. Notice of Violation F. Voluntary Emission Reduction Agreement <br /> Is th is application being submitted as a result of receiving a I Ls this project part of a larger project for whieb there is a Voluntary <br /> Notice of VioMon(NOV)from the District? Emission Reduction A-a=ment(VERA)with the District? <br /> - I - <br /> F3 No Yes,NOV "ut No Yes, VERA# <br /> [G. OUonal Section <br /> Do you want to receive inforinarion about the Pealthy Air Living Business Partners Pro2yam? Yes No <br /> FOR APCD USE ONLY <br /> Central Region Office: 1990 E.Gettysburg Ave.Fresno,CA 93726-0244 TEL(559)230-6000 FAX(559)230-6061 WEB <br /> Paae I of 12 ResidentiaVNon4:Zes)dentiaYMDced-Use Apprication Form Revised June 28,2019 <br />