Fillable Env Info Appendix H APPENDIX H

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Env Info Appendix H APPENDIX H

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(revised 4/12/16)
Form Appendix H
BAY AREA AIR QUALITY MANAGEMENT DISTRICT
375 Beale Street, Suite 600. . . San Francisco, CA 94105. . . (415) 749-4990. . . FAX (415) 749-5030
Website: www.baaqmd.gov
APPENDIX H
ENVIRONMENTAL INFORMATION FORM
(To Be Completed By Applicant)
Date Filed:
General Information
1. Name and address of developer or project sponsor:
2. Address of project:
Assessor’s Block and Lot Number:
3. Name, address, and telephone number of person to be contacted concerning this project:
4. Indicate number of the permit application for the project to which this form pertains:
5. List and describe any other related permits and other public approvals required for this project, including
those required by city, regional, state, and federal agencies:
6. Existing zoning district:
7. Proposed use of site (Project for which this form is filed):
Project Description
8. Site size.
9. Square footage.
10. Number of floors of construction.
11. Amount of off-street parking provided.
12. Attach plans.
13. Proposed scheduling.
14. Associated project.
15. Anticipated incremental development.
2
16. If residential, include the number of units, schedule of unit sizes, range of sale prices or rents, and type
of household size expected.
17. If commercial, indicate the type, whether neighborhood, city or regionally oriented, square footage of
sales area, and loading facilities.
18. If industrial, indicate type, estimated employment per shift, and loading facilities
19. If institutional, indicate the major function, estimated employment per shift, estimated occupancy, loading
facilities, and community benefits to be derived from the project.
20. If the project involves a variance, conditional use or rezoning application, state this and indicate clearly
why the application is required.
Are the following items applicable to the project or its effects? Discuss below all items checked yes. Attach
additional sheets as necessary.
Yes No
21. Change in existing features of any bays, tidelands, beaches, or hills, or substantial
alteration of ground contours.
22. Change in scenic views or vistas from existing residential areas or public lands or
roads.
23. Change in pattern, scale or character of general area of project.
24. Significant amounts of solid waste or litter.
25. Change in dust, ash, smoke, fumes or odors in vicinity.
26. Change in ocean, bay, lake, stream or groundwater quality or quantity, or
alteration of existing drainage patterns.
27. Substantial change in existing noise or vibration levels in the vicinity.
28. Site on filled land or on slope of 10 percent or more.
29. Use of disposal of potentially hazardous materials, such as toxic substances,
flammables or explosives.
30. Substantial change in demand for municipal services (police, fire, water, sewage,
etc.).
31. Substantially increase fossil fuel consumption (electricity, oil, natural gas, etc.).
32. Relationship to a larger project or series of projects.
3
Environmental Setting
33. Describe the project site as is exists before the project, including information on topography, soil stability,
plants and animals, and any cultural, historical or scenic aspects. Describe any existing structures on
the site, and the use of the structures. Attach photographs of the site. Snapshots or Polaroid photos will
be accepted.
34. Describe the surrounding properties, including information on plants and animals and any cultural,
historical or scenic aspects. Indicate the type of land use (residential, commercial, etc.), intensity of land
use (one-family, apartment houses, shops, department stores, etc.), and scale of development (height,
frontage, set-back, rear yard, etc.). Attach photographs of the vicinity. Snapshots or Polaroid photos will
be accepted.
Certification
I hereby certify that the statements furnished above and in the attached exhibits present the data and
information required for this initial evaluation to the best of my ability, and that the facts, statements, and
information presented are true and correct to the best of my knowledge and belief.
Date Signature
For
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Env Info Appendix H APPENDIX H

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Completed 18 April 2020

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