Merced County Login Request
Asterisks (*) indicate required fields
InstructionsThis form is to be completed by the business owner or corporate officer to request a username and password in order to access the Portal. If you wish to grant another individual authorization, complete this form with THAT individual's information and attach the signed authorization statement. Use the notes section to provide specific information as needed. The System Administrator will contact you within 72 hours.
Request Date*
Last Name*
First Name and MI*
Business Name*
Facility Address*
City*
Zip*
Phone*
Email*
Your relationship to the business*
Business Owner
Authorized by Business Owner
Additional Notes
Regulated Programs*
Hazardous Materials
Hazardous Waste
Tiered Permitting
Underground Storage Tanks
CalARP
Aboveground Petroleum Storage Tanks
Authorization Letter
Upload
Date
Submit
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