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fi. Principal Business Activity: <br />7. Building Code Class: per UBC; Example B2 or H~} <br />8. Number of Employees; 9. Number of Shifts: <br />Io. Hours of Operation: <br />11. Other hazardous materials related permits: <br /> ~e.g.: Permits and/or identification numbers from Dept. Health, <br /> Public Works Wastewater Division, DEQ, EPA, Lane Regional Air Pollu- <br /> tion Authority, etc.} <br /> List permit, agency and permit number: <br />1Z. General Land Use Narth South East West <br /> Within 1 Mile: <br />13. Adjacent Property North South East West <br /> Use: <br />I4. Special Land Uses Within 1 Mile: <br />15. Declaration Must be signed by executive officer or his authorized rep- <br />resentat~ve listed above} I certify that the information above and on <br />the following parts is true and correct to the best of my knowledge. <br />Signature: Date: <br />Title: Print Name: <br />PART B - GENERAL FACILITY DESCRIPTION Site Plan <br />Provide a site plan on 8-I/Z by I1 inch paper showing the location of all <br />buildings and structures, chemical loading areas, parking lots, internal <br />roads, storm and sanitary sewers, surface waters and wells. Indicate the <br />approximate scale, northern direction and date the drawing was completed. <br />PART C - FACILITY STORAGE MAP Confidential Information <br />1. Provide a flour plan of each building on 8-1/~ by 11 inch paper with <br />approximate scale and northern direction, showing the location of each <br />storage facility see definition on Page I}. Mark map clearly "Confi- <br />dent~al - Do Nat Disclose". <br />2. Identify each storage facility with an ID number, letter, name or <br />symbol . <br />3. Show the following: <br />a. Accesses to each storage facility. <br />Ordinance - 78 <br />