DocuSign Envelope ID: 568116C2-9FBF-4313-AF5F-D3B561C1931F REV 1/5/2022 Cannabis License Application Page 54 of 68
THE CITY OF
ENVIRONMENTAL
INFORMATION O BARSTOW
AND
CHECKLIST FORM CROSSROADS OF OPPORTUNITY
(to be completed by applicant)
Date Filed: Planning Case No.
1. Developer or Project Sponsor:
Name: 2119 Building, inc
Address: 2590 Mercantile Way, Bldg 19, Unit / B, Barston City: State: CA Zip: 92311
Barstow
2. Address of project:
2590 Mercantile Way Barstow CA 92311
3. Assessor's Block and Lot Number : 0428-211-26-0000
4. Primary Project Contact
Name: Alen Tatevosian Phone: 818-279-3680
Address: 2590 Mercantile Way, Bldg 19, Unit. B, Barstov Email: [email protected] City: Barstow
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:
Local building and safety permits - Sate Cannabis Licenses - Department of Fish & Wildlife Lake & Streambed Alteration Agreement - State Water Control Resources Board Water Quality Protection Permit
6. Existing zoning district: Commercial
7. Proposed use of site (Project for which this form is filed):
Commercial Cannabis Activity - Dispensary - Cultivation - Manufacturing - Distribution - Non Store Front Deliver - Special Events
PROJECT DESCRIPTION
8. Site size: 1.279,793 sqft / 29.38 Acres
330.000 soft
9. Square footage:
10. Number of floors of construction:
11. Amount of off-street parking provided and number of employees per shift/total:
Ample Parking on Site
12. (Attach Plans)
13. Anticipated incremental development (i.e., phasing):
1 Phase
14. If this is a commercial project, indicate the type of project, whether neighborhood, city or regionally oriented, square footage of sales area, and loading facilities:
That are ty sated within the facily i be asters one of tie air ration inse rail as are or are cas and sold into the commercial market
15. If this is an industrial project, indicate the type of project, estimated employment per shift, and loading facilities:
none
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 568116C2-9FBF-4313-AF5F-D3B561C1931F REV 1/5/2022 Cannabis License Application Page 55 of 68
16. If this is an institutional project, indicate the major function, estimated employment per shift, estimated occupancy, loading facilities, and community benefits to be derived from the project:
none
17. If the project involves a variance, conditional use permit, or rezoning application, state this and indicate clearly why the application is required:
This project requires a Conditional Use Permit as part of the City of Barstow Cannabis Licensing process Are the following items applicable to the project or its effects? Discuss below all items checked yes (attach additional sheets as necessary).
YES
18. Change in existing features of any hills, or substantial alteration of ground contours.
19. Change in scenic views or vistas from existing residential areas or public lands or roads.
20. Change in pattern, scale or character of general area of project.
21. Significant amounts of solid waste or litter.
22. Change in dust, ash, smoke, fumes or odors in vicinity.
23. Change in lake, stream or ground water quality or quantity, or alteration of existing drainage patterns.
24. Substantial change in existing noise or vibration levels in the vicinity.
25. Site on filled land or on slope of 10 percent or more.
26. Use or disposal of potentially hazardous materials, such as toxic substances, flammables or explosives.
27. Substantial change in demand for municipal service (police, fire, water, sewage, etc.).
28. Substantially increase fossil fuel consumption (electricity, oil, natural gas, etc.).
29. Relationship to a larger project or series of projects.
ENVIRONMENTAL SETTING
30. On a separate page, describe the project site as it 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, digital or polaroid photos will be accepted.
31. On a separate page, 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, ett.). Attach photographs of the vicinity. Snapshots, digital or polaroid photos will be accepted.
NOTE: Before the Lead Agency can accept this application as complete, the applicant must consult the lists prepared pursuant to Section 65962.5 of the Government Code and submit a signed statement indicating whether the project and any alternatives are located on a site which is included on any such list, and shall specify any list.
CERTIFICATION
I hereby certify that the statements furnished above and in the attached exhibits present data and information required for this initial evaluation to the best of my ability, and that the facts, statements, and in formation presented are true and correct to the best of my knowledge and helie by:
alen Taterosian 3/26/2022
-T4FDTEA57395470.
Signature: Date:
2119 Building Inc.
For:
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 568116C2-9FBF-4313-AF5F-D3B561C1931F REV 1/5/2022
Cannabis License Application Page 56 of 68
HAZARDOUS WASTE AND SUBSTANCES STATEMENT
The development project and any alternatives proposed in this application are contained on one or more of the lists of hazardous waste sites and facilities compiled pursuant to Section 65962.5 of the Government Code. Accordingly, the project applicant is required to submit a signed statement which contains the following information:
1, Name of applicant: 2119 Building Inc. Alen Tatevosian
2. Address: 2590 Mercantile Way, Bldg 19, Unit. B, Barston
3. Phone Number: 818-279-3680
4. Address of Site (street name and number if available, and ZIP code):
2590 Mercantile Way, Bldg 19, Unit A, B, & C, Barstov
5. Local Agency (city/county): City of Barstow / San Bernardino Co
6. Assessor's book, page, and parcel number: 0428-211-26-0000 Book139, Page 3
7. Specify any list pursuant to Section 65962.5 of the Government Code:
8. Regulatory identification number:
9. Date of List:
- DocuSignod-byr
len Tatenosian 3/26/2022
• TAFDTEAS7395470
Signature: Date:
2119 Building Inc.
For: (Applicant)
220E Mountain View St. Ste A • Barstow, CA 92311• (760) 255-5161 • https://www.barstowca.org/home