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1/02/99 TUE 10:45 FAX 209 249 2210 MANTECA LOANS 11002/005 <br /> '.E/26/1999 15:04 20959*-.2 GEOLOGICAL TEC•CS PAG 03103 <br /> + GREEN FORM <br /> :MASTER FILE RECORD INFORMA'T'ION "MFR" <br /> 10-26-1999 <br /> 5W,Qmuv.Asv;mRHO y&Ibw UNIT IV <br /> D 0 5 8 3 OWNER FILL: <br /> camp4g-TF IEFmi-awmicPROPERTY OWNER IMFORMAT1OM.' C+ � N�Cir TL''°""x�""'''EMD <br /> PROPERTY Jerry DeGrOdt PndWK 209-471 -1787 <br /> 1 QfYNGR NAME <br /> BUOINEsaNAM 0010 � � 80036otTAXIDN t`'� _ aoDv(p <br /> C. DeGroo't & Sons a Cifornia r _ <br /> Owner Nome Addre&a , .Q ► Z -7 C� <br /> Old 908 Rlihy R ori, V = 6rnte b� <br /> u state C A alp <br /> +IIr,g agar..•cls (Z.: o ,-� .• <br /> n-^R�4�TIOM❑ Ikomqup.R n PART IM-M a -- F®AGENCY❑ rr <br /> FACIUTY FILE <br /> MEW <br /> ,�IoWI-FrETMEFiOUDMNG BUSINESS l FACILITY I SITE/IVF 1?ffAT1QAF- <br /> '.s t1w a NEW guelnecm LOCATION not prevloualy regulated by the ENIJIRONMEWYai 1IEALY4 DWtaloN 4 Yes Q No <br /> 3 this ett EJu>mKo Busmass LorAT"but a NEwT/PE of regutsted Business? Yes ❑ No <br /> Buvnff lFsmvffl9rre NAM& <br /> Brae AbGREtB SUFTtf SUOIName PNONE <br /> (13737 Guth Airport Way (APN##1 96-03-3) Z c?cl _y� <br /> crry Manteca sT4�CA zip 95336 <br /> MsHing Addreas IfDIFFERENTfiDm FjW#1 yAddrees Attention, or Cars Of(opdonaQ <br /> fiWiling Address Oft SrATti ZIP <br /> THIRD PAWrY BILLIKO INFOI Gumplefe if Billing Party is dhTurentfrom Proparty Owner orFecility Operator kkmMiedabove- <br /> 3=NESS NOYE Attention:or Cars Of (opUonat? <br /> L111,169 Address PHONE <br /> tm STATO ZIP <br /> Em for fees:and otla ds OWNER FAOILITY11RUSINK" THIRD PAKTY BILLING <br /> en ma"a 0omnumrm A2gowLL'aAls LNr. I,the&ademIptad 4plk&ak w*tl&0 I am dm 0 -a,4pn'atar,Or,fjAdr4eApw of tht Bo b—ta,and 1 admowledze that All <br /> 1'b!mmFEL;Pmavas,FNP MC bdUvrC94&M auWorJ70VAtyCUAW#S ueudaud wkb!this Operntivu wo be mmBd to=d&a addmm ldaa Mad&Dove m the AC W0NTADD§W8 <br /> ter*13 slo- X abo aemy not all iatarstatlm provided on this xMbmtioe It eruct ami oormti and t6al all regudnted adivltla wM be performed to a000&dawe with all appivable SAN <br /> JoAom CoUntr Ordlrum Cow and/or SumdmnU tad STATE malar FrvmuL LAaa and Reeakkloat. Ai the wLd&m%nad ewner,operator,(Lr spent of the property lasted al eke <br /> above kdllpfAlse&ddmA A tereby VWMFim the reletu of any arae as 1— its sad atvlrodmatal aummeat laformawm to sAN IoAQUIN COVM 1NM0NMFNPA1, <br /> RFALIM DIVMON act WO si N It araiW)b nae at the&Mme Uma it Is Fronded w me or My tgtMUllatim <br /> APPLICANT MANE' C. DeGroot,& Sons SIGNAL3JR-$,Z7c" " ';1••- <br /> ...,.ter.,...►- _���� �. _.._ ,��.�,�.� .... : , <br /> DRIVER'e WCE'NSE* <br /> 'nTLE Partner �wdreenwweely�L 0 13L, O O <br /> ILL <br /> q •d NlO��+ WdLE5W L-5Z-0 1 <br />