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SAN JOAQULN VALLEY UNIFIED <br /> AIR ,.. )LLUTION CONTROL DIS'._,.ICT <br /> 4230 KIERNAN AVENUE. SUITE 130, MODESTO. CA 95356 <br /> (209) 557-6400 <br /> ATTENTION: FILE NUMBER: 01--160 <br /> To Be Filled Out By Appiicant JAN 1 1 2XI <br /> .tom FR <br /> . l y 1 r.E_F EMERGENCY ibWM�S <br /> BUSINESS NAME: �, <br /> � ,, ��e� <br /> SITE ADDRESS: 25 1% 3 <br /> Contact Name: `�C�m tmA\Ct _ Phone:�- <br /> 1D�o <br /> Please Check The Appropriate Box: <br /> Will any load bearing structures be removed? . . . . . . . . . . . . . . . . . . . YES [ ] NO 11 <br /> Will 260 linear feet or more of any building material be disturbed? . . . . . . YES [-T,�NO [ ] <br /> Will 160 square feet or more of any building material be disturbed? . . . . . YES ( NO [ ] <br /> Will 35 cubic feet or more of any building material be disturbed? . . . . . . . YES [� NO [ l <br /> For District Use Only <br /> The business has be-_n identified as being exempt from the requirements of <br /> the APCD. <br /> The business is subject to the permit requirements of the APCD. The <br /> applicant has filed a complete application with the APCD. <br /> The business has obtained the necessary permits or authorizations from the <br /> APCD. <br /> The business is NOT meeting the APCD requirements. The building permit <br /> process may not proceed and a Certificate of Occupancy may not be issued. <br /> The applicant shall submit an asbestos notification and survey to the APCD <br /> within 10 working days prior to asbestos removal. <br /> The building permit process may continue subject to the following <br /> conditions: <br /> APCD APPROVAL BY: DATE: <br />