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SU0014920
Environmental Health - Public
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SU0014920
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Last modified
5/25/2022 12:18:31 PM
Creation date
5/11/2022 8:31:58 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0014920
PE
2666
FACILITY_NAME
PA-2200060
STREET_NUMBER
1804
Direction
W
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204-
APN
12319106
ENTERED_DATE
5/10/2022 12:00:00 AM
SITE_LOCATION
1804 W COUNTRY CLUB BLVD
RECEIVED_DATE
5/9/2022 12:00:00 AM
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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PA24AN ^ ' 00063.900URVAL� <br /> 'A2200060 F EY UNIFIED AIR POLLU'T'ION CONTRes , OL DISTRICT <br /> COMPLIANCE QUESTIONNAIRE <br /> 4800 ENTERPRISE WAY,MODESTO,CA 95356 <br /> (209)557-6400•FAX(209)557-6475 <br /> ATTENTION: FILE/PERMIT NUMBER: <br /> TO BE FILLED OUT BY APPLICANT FOR NEW DEVELOPMENTS OR PROJECTS INVOLVING <br /> DEMOLITION AND/OR RENOVATION AND SUBMITTED TO THE SJVAPCD OFFICE ABOVE <br /> BUSINESS/PROJECT NAME: Cc LAA CNt C\U h L+G UUC 17-n TODAY'S DATE <br /> PROJECT SITE ADDRESS: �6 O `1 - 1�CO� t�� �tl t y C kuVj %�w g� CITY: S1UGlh O��l <br /> CONTACT NAME: NO& N1ohc�Mrn.� PHONE#:(a 6q) 5.2 i—0 QAx#: <br /> DEVELOPER: PHONE#: FAX#: <br /> PROJECT DESCRIPTION: TI EMAIL: <br /> NESHAP(Rule 4002-Building Demolition/Renovation) <br /> 1. Will any load-bearing structure be removed?......................................................................................................YES[ ]NO[3] <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[X] <br /> Greater than 160 square feet of interior or exterior wall,flooring,ceiling,roofing,ducting or other material..................YES[ ]NO[x] <br /> Greater than 35 cubic feet of other building material debris..............................................................................YES[ ]NO[70 <br /> Indirect Source Review(Rule 9510) (Rules available at www.valleyair.org) <br /> 3. Type of Space To Be Constructed(check all that apply) [x[ Commercial [ ] Residential [ ] Educational [ ] Light Industrial <br /> [ ] Heavy Industrial [ ] Medical Office [ ] General Office [ ] Government [ ] Recreational [ ] Other/Unidentified <br /> 4. Square Footage of Building(s)to he Constructed 3370 ftz [id Tenant 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 I or more acres of land be disturbed as part of this project?............................................................................YES[ ]NO[19 <br /> 7. Will 2500 cubic yards of material be excavated or relocated on any 3 days during the project?.........................................YES[ ]NO[AJ <br /> FOR SJVAPCD USE ONLY <br /> [ ] Asbestos/NESHAP requirements satisfied OR in progress <br /> i <br /> Comments <br /> ( [ Regulation VIII(Must Control)requirements satisfied OR in progress <br /> Continents <br /> [ ] Indirect Source Review requirements satisfied OR in progress <br /> Comments—- -. _�.- ---- — —-- — —— - —_ <br /> I <br /> REVIEWED BY, DATE: <br /> i <br /> Cam Qucstionnaire.doc Revised 12/23/15 <br />
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