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Placer County Air Quality Supplemental Questionnaire

The Placer County Air Quality Supplemental Questionnaire (questionnaire) was designed to assist in determining if a building permit applicant may be an air pollutant or hazardous air pollutant source, to ascertain the applicability of air permitting and Dust Control Plan or NOA (Naturally-Occurring Asbestos) Dust Mitigation Plan requirements, and to determine if hazardous materials meet listed criteria, and/or if a Risk Management Plan (RMP) or Hazardous Materials Business Plan (HMBP) is required. This questionnaire was produced to be given to building/grading permit applicants by permit-issuing jurisdictions.

Placer County and the incorporated municipalities' building departments, by statute are required to determine whether compliance with statutory requirements to submit Risk Management Plans (RMPs) or to provide air pollution disclosures, have been satisfied prior to making the finding that building/grading permit applications are complete

To assist building/grading permit issuing jurisdictions in meeting statutory mandates and in conjunction with the Placer County Environmental Health Division, the Placer County Air Quality Supplemental Questionnaire was developed by District staff for building/grading permit applicant completion. If any question is answered “Yes”, the questionnaire should be forwarded to the District for Placer County Environmental Health and/or Air District approvals.

The following are samples of Supplemental Questionnaires provided to Placer County Jurisdictions:

City of Auburn Sample Questionnaire

City of Colfax Sample Questionnaire

City of Lincoln Sample Questionnaire

Town of Loomis Sample Questionnaire

City of Rocklin Sample Questionnaire

City of Roseville Sample Questionnaire

The questionnaire is initially given out by the Jurisdictions or Issuing Building Departments, forwarded to the Air Pollution Control District and by the District to Placer County Environmental Health as required, and then returned to the Building Departments for filing.

The California Health and Safety, and Government Codes’ requirements regarding hazardous materials and air pollution information disclosures are the driving force for the questions listed on the questionnaire.