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REV. 04/09/99 <br />SAN JOAQUIN COLIN' _ ,JUBLIC HEALTH SERVICES B ENVIRONMENTAT HEALTH DIVISION <br />MASTERFILE RECORD INFORMATION <br />DATE I i 9 /,?r /nn I 0wn1.IDI I Ob0 I _r05 CAS[( <br />OWNER FILE <br />COMPLETE THE FOLLOWING BUSINESS OWNER INFORMATION: <br />CHECK' OWNER CUMENnY ON(ILE WIEN EHO <br />Wwass OWxe NN.0 <br />ENVIRONMENT HEALTH <br />F.Cvn AWHssovcuuAhvwY AOOKM <br />400A N. Cluff Ave. <br />A <br />' <br />Guthrie, C.E.O. <br />ENGINEDick (209) <br />339-0336 <br />rs1 <br />ID <br />95240 <br />ROAro os SurtweoE Dnlocs locAroNcaa <br />Ast <br />KM <br />HEALTH EERMD MAILING ADDRESS (I D1FFERENT Ewn hLeWitY Addrev) <br />same <br />W-111 N. VDIFFEREMAom S,.wwN ) <br />AMMMn a Ca. a (WO.' 9 <br />Dick Guthrie <br />SOCSECITAAIDE <br />Ow+.r+HOrnF Anottu <br />9786 Twin Cities Rd. <br />:Y <br />SIC COOS <br />ory Galt <br />nA" Ca. <br />"' 95632 <br />DNH[R MARuc AWRF53 (/DIFFFREM Wan OwnerAd2evd <br />400A N. Cluff Ave. <br />Ah.flos-a CcreoT (opLona) <br />Dick Guthrie <br />Mm" Address City <br />Lodi <br />Stole <br />Ca. <br />z <br />95240 <br />hrt a OWNEbvu <br />CORPORATION 4 X I INDNIDUALIn I PARINEnHIP1111771 I <br />LOCAIAGENCYO COUNTYAGENCYIC I STATE AGENCY <br />FED AGENCY d On1ER III <br />p' FACILITY FILE D <br />FACILIN IDM D O �°ZO / CRO35 REF IDE ACCO/ I <br />COMPLETE THE FOLLOWING BUSINESS FACILITY INFORMATION: APR 5 2001 <br />Ws1N1ZfFACK1n N., NN ONTHE HEALTH PERMIT) <br />J S D Auto Body, Inc. <br />ENVIRONMENT HEALTH <br />F.Cvn AWHssovcuuAhvwY AOOKM <br />400A N. Cluff Ave. <br />3uaE <br />A <br />&NI+FSS P110NF <br />(209)339-0336 <br />C. DP CwwIssARr ARREEss <br />Lodi <br />STAKE <br />Ca. <br />ID <br />95240 <br />ROAro os SurtweoE Dnlocs locAroNcaa <br />Knl <br />KM <br />HEALTH EERMD MAILING ADDRESS (I D1FFERENT Ewn hLeWitY Addrev) <br />same <br />AMMMn a Ca. a (WO.' 9 <br />Dick Guthrie <br />Moiing.Addless ply <br />STwrt <br />:Y <br />SIC COOS <br />APN <br />CaARXIrt <br />' A99Es.1M..A(of I"& andchalgisS OWNER FACILITY/BUSINESS <br />BILIAW; AND COMPLIANCE ACKNOWLEDGMENT; 1, the undersigned Applicant, certify that I am the Owner, Operator, or <br />Authorized Agent of this Business, and I acknowledge that all PERs117' FEES, PENALTIES, ENFORCESIENT CoA RGES and/or HOURLY <br />Cit. iII associated with this operation will be billed to nde at the address identified above as the A C'C'OVNT AbURF.SS' for this site. t <br />also certify that all information provided on Ibis application is true and correct; and that all regulated activities will be performed <br />in accordance with all applicable SAN JOAQUIN COUNTY Ordinance Codes and/or Standards and STATE and/or FEDERAL Laws <br />and Regulations. <br />""CAM NAME os. PMD <br />Dick Guthrie <br />n NATI <br />WILE c. F_ n_ I RW&UMMd) I <br />DON <br />