DocuSign Envelope ID: 2E5EC956-7257-4484-BF28-6126A32DEE9F 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: Winners Circle HD, LLC
Address: 258gMercantile Way, Bldg 18,
City: Barstow State: CA Zip: 92311
2. Address of project:
2588 Mercantile Way Barstow CA 92311
13. AssessorS Blockand Lot Numbere 0428-211-26-0000
4 Primary Project Contact
Name: Norair Madatian Phone: 818-522-2220
Address2588 • Mercantile Way, Bldg 18, Email: [email protected] State: CA Zip: 92311
City:- Barstow
butand describe any otherrelated permits and other public approval, required forths project, indüding those reguired by cl regional, state and federal agencies:
We anticipate needing a demolition permit, tenant impovement building permits, a landscape permit, minor electrical building permit, sign permits and a business license from the city. Other agencies are not expected to be party to this build.
6. Existing zoning stacte Commercial
7 Proposed us: (Project for which this form is filed):
Retail Cannabis Dispensary
PROJECT DESCRIPTION
8 Site size: 29 acres
9. Square footage: approximatley 4,000 feet renovation of a 12,960 sq foot existing building o Number of floors of construction 1
a. Amountot offstreet parking provided and number of empl oyees per shift/total 60 parking spots for customers and 30 spots for employees in a seperate designated area. 12 (Attach Plans)
is Anticipated incremental development (le phasing);
1 Phase
i4. 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 will have a sales floor area of about 2000 sq feet
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: 2E5EC956-7257-4484-BF28-6126A32DEE9F 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 projects none
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 Licenseing process, 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.
V 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, sparegraph ore it, a shot, lies, or plant photos wil be celesh, frontage, set back, rear yard, e., Atch 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.
3/26/2022
-B7D6777B9BF04A9... Date:
Signature:
Winners Circle HD, LLC
For:
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home DocuSign Envelope ID: 2E5EC956-7257-4484-BF28-6126A32DEE9F 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: Winners Circle HD, LLC
2. Address: : : Mercantile Way, Bldg 18, Barstow CA 92311 2588
3. Phone Number: 818-522-2220
4. Address of Site (street name and number if available, and ZIP code):
--- Mercantile Way, Bldg 18, Barstow CA 92311
2588
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:
3/26/2022
Signature: -B7D6777B9BF04A9... Date:
Winners Circle HD, LLC
For: (Applicant)
220 E Mountain View St. Ste A • Barstow, CA 92311 • (760) 255-5161 • https://www.barstowca.org/home