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San Joaquin County Environmental Health Department <br />Application Form <br />Facility Name <br />MEHAL COMPANY INC. DBA QUICKI KLEEN CAR WASH <br />State ZIP 95336CA <br />APN Supervisor District <br /> Consultation S Change of Owner Repairs or Remodel Other <br />License Plate Number VIN <br />S Facility Owner Billing Party Facility Contact Property Owner Contractor Architect <br /> Billing Party Facility Owner Facility Contact Contractor Property Owner Architect <br />If contractor, indicate type and license numberFirst Name Last nameMANVINDER RATHOUR <br />State ZIPCA 93637 <br />Phone <br /> Billing Party Facility Owner Facility Contact Property Owner Contractor Architect <br />If contractor, indicate type and license numberFirst Name Last name <br />Address City State ZIP <br />EmailPhonePhone <br /> Property Owner Contractor Facility Owner Facility Contact Billing Party <br />Last nameFirst Name <br />City StateAddress <br />EmailPhonePhone <br />07/08/2025DATE: <br />StO PE RATO R / MANAGER OTHER AUTHORIZED AGENT PROPERTY / BUSINESS OWNER <br />Title <br />Assigned ToAccepted By <br />Contact Types <br />required <br />If mobile food truck or <br />pumper truck <br /> Application for <br />Operating Permit <br />Email <br />quickikleencarwash@gmail.com <br />If APPLICANT is not the BILLING PARTY, proof of authorization to sign is required <br />AUTHORIZATION TO RELEASE INFORMATION: When applicable, I, the owner or operator of the property located at the above site address, hereby authorize the <br />release of any and all results, geotechnical data and/or environmental/site assessment information to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT as soon as it is available and at the same time it is provided to me or my representative. <br />Phone <br />(559) 223-5659 <br />BILLING ACKNOWLEDGEMENT: I. the undersigned property or business owner, operator or authorized agent of same, acknowledgetl <br />specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project or activity will be billed to me or my business as id^iftft4ypy45^ <br />form. <br />I also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN JOAQUIN COUNTY Ordinance Codes, <br />Standards, STATE and FEDERAL laws. <br />APPLICANTS SIGNATURE: <br />Type of Service <br />Requested <br />Comments <br />Datv/^/2i <br />^MADERA <br />Linked FA ID _ ___ <br />Record Number____ <br />City <br />MANTECA <br />Ad'lre“l423 SAN PIETRO DRIVE <br />(9^' <br /> Architect <br />If contractor, indicate type and li <br />Site Address <br />707 E. YOSEMITE AVE