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AIR POLLUTION CONTROL DIST CT <br /> 4230 KIERNAI VENUE, SUITE 130, MODESTgWA 9534CEIVED(209) 557-6400 <br /> ATTENTION: FILE NUtiIBER: AUG 16 2p01 <br /> MApU1N rA11NP1 <br /> Ex 1as y, p4ze, gvebOkl•} C s"-oM, � <br /> J ^n To Be Filled Out By Applicant <br /> BUSINESS NAME: f v IG 1/�✓Zc�t��� lgg� <br /> SITE ADDRESS: 2X05 "vw <br /> Contact Name: e LcVL G v Phone: U <br /> C1llo ��ilO2 <br /> Please Check The Appropriate Box: <br /> Will any load bearing st uc-ores be re...oved? . . . . . . . . . . . . . . . . . . . YES NO [ ] <br /> W111 :260 liner fee: cr more of any building r..ate,^:al be disrlrbed? . . . . . . YES NO [ ] <br /> Will 160 square feet or more of any building mate^aI be disturbed? . . . . . YES NO [ ] <br /> Wiil 35 cubic feet er store of any bu:iding :..ace ai be disturbed? . . . . . . . YES NO [ ] <br /> For Diss ct Use Only <br /> •rine business has been idendfied as Leung exempt from the recuirements or <br /> the APCD. <br /> The business is subiect to the permit requirements of the APCD. The <br /> applicant has filed a cemplete application with the APCD. <br /> The business has obtained the necessary permits or authorizations from the <br /> APCD. <br /> The business is NOT me--:in- the APCD ric'uiremens. The building pe-r-nit <br /> process may net proceed and a Ceral'icate of Occupancy may net be issued. <br /> FCD <br /> The applicant shall submit an asbestos notification and surrey to the A_- <br /> within 10 working days prior to asbestos removal. <br /> The building per—mit process may continue subject to the followin; <br /> conditions: <br /> APCD APPROVAL BY: DATE: <br />