DocuSign Envelope ID: 33981C23-BB38-4903-82AE-F8D9EOCDE5C5 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
Name: K.H.G Group, LLC
Address: 2586 Mercantile Way, bldg 17
Barstow State: CA Zip: 92311
City:
2, Address of project.
2566 Mercantile Way Barstow CA 92311
3. Assessor's Block and Lot Number& 0428-211-26-0000
4. Primary Project Contact
Name: Hermine Zohrabyan Phone: 818-431-0708
Address: 2586 Mercantile Way, bldg 17 Email: [email protected] Barstow State: CA Zip: 92311
City:
5, List and describe any other related permits and other public approval required for this project, including those required by city regional, state andifederal agencies:
Local Building and safety permits- Stile Cannabis License - Department of Fish and 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 Delivery - Special Events
PROJECT DESCRIPTION
8 Site size: 1,279,793 sqft / 29.38 Acres
9. Square footage: 330,000sqft
to Number of floors of construction
11. Amount of off street parking provided and number o
Ample Parking on Site
12 (Attach Plans).
3 Antipated incremental development leaphasingla
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:
This is a neighborhood regional project and this will be a cultivation facility with no retail sales area. All products cultivated within the facility will be transferred to one of the distribution licensed facilities for further packaging and sold into the commercial market
15. 1fthis is an industratproject indicate the type of project, estimated employment per shift, and loading facilitiess none
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 33981C23-BB38-4903-82AE-F8D9E0CDE5C5 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 proéc involves a variance, conditionaluse permit, or reroning application, state this and indicate deally why the application is required:
This Project requires a conditional Use Permit as part of the City of Barstow Cannabis Licensing processing Are the following items applicable to the project or its effects? Discuss below all items checked yes (attach additional sheets as necessary).
YES NO
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.).
X 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, etc.). Attact hotographs 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 belief pocusigned by:
Hermine Ederalyan 3/26/2022
-CC069498388847 Date:
Signature:
K.H.G Group LLC
For:
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 33981C23-BB38-4903-82AE-F8D9EOCDE5C5 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: K.H.G Group LLC Hermine Zorabyar
2. Address: 2586 Mercantile Way, bldg 17, Barstow CA 92311
3. Phone Number: 818-431-0708
4. Address of Site (street name and number if available, and ZIP code):
2586 Mercantile Way, bldg 17, Barstow CA 92311
5. Local Agency (city/county): City of Barstow / San Bernardino County
6. Assessor's book, page, and parcel number: 0428-211-26-0000 book 139, page 3
7. Specify any list pursuant to Section 65962.5 of the Government Code:
8. Regulatory identification number:
9. Date of List:
-DocuSigned.by:
Hermine Zourabyan 3/26/2022
-G6069A9B3B88471...
Date:
Signature:
K.H.G Group LLC
For: (Applicant)
220 E Mountain View St. Ste A Barstow, CA CA92311 • (760) 255-5161 • https://www.barstowca.org/home