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HomeMy WebLinkAboutX2013-2519 - MiscCITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 I Newport Beach, CA 92658-8915 www.newportbeachca.ciov I (949) 644-3200 HAZARDOUS MATERIALS QUESTIONNAIRE If the answer to any of the questions below is yes, applicant must contact the Fire Prevention Office, 100 Civic Center Drive, P.O. Box 1768, Newport Beach, CA 92658-8915. Telephone: (949) 644-3106. Business Name Contact Person Telephone T `( t. P4ll ©'Fokrke_ 'ilk-5?* -1Ez:5 Mailing Address City State Zip I 1F550 Fi-O'\ 1 ivie_ Cps- 6jL( 14 Sate Address City Zip dnt k4iDa Dci' 'Newvort- ?mch a c 121.05 YES 1. ❑ Will your business activity generate Hazardous Waste in any quantity, in any physical form (solid, liquid, gas)? 2. 3. n a 4. ❑ Will your business at any one time store, use or handle Hazardous Substances in quantities equal to or greater than 55 gallons, 500 pounds or 200 cubic feet of compressed gas? Will your business store, use or handle Carcinogens or Human Reproductive Toxins in any amount? Will your business use an existing or install an Underground Storage Tank for Hazardous Substances or Hazardous Wastes? 5. n g Will your business store, use or handle Acutely Hazardous Materials? 6. ❑ If your business will be handling Acutely Hazardous Materials, will your business be located within 1,000 feet from the outer boundary of a school? Briefly describe the nature of the business activity: -The, 1-t-ci j SVP uV 1\ %P >rern2 ejt�ri • 11>Q �1cm,a,5 INity li�il \Ni.0 hoc Se '-Hn .„ ten porart sPD • This relo<c Printed Name ofResponde Circle one: owner �CO idknthartellant lessee agent engineer I declare under penalty of erjury that to the best of my knowledge and belief the responses made herein are true and correct. gtaatt�r"e=� For NBFD-Fire Prevention Use Only YES NO Reviewed By: Business Plan Required 1orms\Hazquest 3/11/09 Plan Check No. Date