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11/02/99 TLE 10:47 FAX 209 249 2210 xANTECA LOANS 0004/005 <br /> 10/26/1999 15:04 209538 CEOLOGtr_AL TECHOS PAGE 02/03 <br /> =10-26-411 <br /> GREEN FORM <br /> MASTER FILE RECORD INFORMATION "MFR" <br /> wro.�No�.E�nr -UNIT IV <br /> OWNER FILE O 1 <br /> GCPPI.k-/>=THEFouaiwNd PROPERTY OWNER NNFORMA770N; CNEOKrF OWblERCw%%" V'oN PILE I"TWEHO <br /> PRdPER1V PwONE <br /> Qw41ER Na11E <br /> Jerry DeGroot 209-4-71 -17R-7 <br /> rlw W W <br /> SUSINESS NAM 1' A'' �o it O{� SOO SEOI7dtl� �r <br /> C. DeGroot & Sons r `I n (/ 1 <br /> Oraster Homs Adelman DRIVER'S LIOEsides - <br /> Ripon (� ( e�"� CA be 95366-2258 <br /> tl�nr eaelllna AitWas lO R_,,_k'J 1+17 <br /> MOWN Addm®CRY (Z,: Q o n scataC� zlp `t S 3 <br /> Ca ,rioN El IIIMiVi0U4LM PARTNCACENCY 71 0n4st <br /> FACILITY PILL <br /> d <br /> 'ClUPLETE THEFOLLOWLNG BUSINESS I FACILITY(SITE INFONMA Tion, <br /> 's this NEW 91NMNS LAOATION riot pre,linuay regulated by the EX»rwN.rENru.H6 TN DMILION 9 yr; E] No x <br /> 's Tlsan EXIST=Rualtwss LOOATION but a NF T'PEofrvouletad Sualness'+ Ycf ❑ No <br /> 1,l"- vFA*%1TYf6rTeNAare _. OL/ <br /> 317E ADORE58 SInTER DVWHEM FRONS <br /> 14253 �outh Airport Way (APN#198-03-4) Zu9 -4 -j 1g1 <br /> Manteca Sr.Te CA na 95336 <br /> MaHing Address 9FDIFF6RENTAvm FaalIV Atldrass Auer,6 ; er Cam Or(Opb'OW <br /> MaIling Add, 2 ORy STAT! air <br /> IS <br /> THIRDPARTYSILUNOINFo; COmp(stB1fBIIIIngParty isdhTerentfromProperty Owner orFacilityOperator ldanXfredabove. <br /> 9umb"(taut Attantlom or Caro Or (apUoda/) <br /> Ma44rg Addraa PHONe <br /> Gtry STATE ZIP <br /> recaatnrr tot fees and charges OMER FAMLiTY11309D1EBi 1-HIND PAPM 61LLING <br /> 3:r,>wINC AW GbMnUNCL AS�,�owrmclti8,r ],tM aadenl6aed Appltunf,rcd�that 1 am err OwRu,Opatdorr or 4aL4u$rd Apeu drtaer ewls>8,aad l aekaoMedte mat s1f <br /> F..frerrFssi•parclb7aLt,ENDWKEe6NI OwI udlorRWMr CNAIDddr woelaed vretb tier spmdon%41 lx bdhd to ns at tic address Ida reed above as Wa AUyNrMaa23ss <br /> fermis atm 1 AM ardty mat M liltmieum prwidrd an 0I appketlos is tae sail mfrect and that W reIlad"vides wM be pertbmeed A Atoardaore with s L apprmbE SAN <br /> 7Or•QOp(balm lAdlaaace Ceder sadloT SleadIIII ad STAn aa4lar FtDw Idlwa and Rtsdador a M the nndrrTigoW owner,aperalot.Or atat orthe Dbperty lotabl at lee <br /> 4`ay..faelYdhNe address, l bacby aetborte d11 ralaaee of ear std all urvlh aid tavimraa lsl Haotouat Afondedien to SAN 70AQVI COUNTY AIVIROM4CNTAL <br /> -VALTH D"ION as Nva ae It b evedI sad at Ike Naas I E w prided to ax Or My apreleafativa <br /> Pi,EISS PAiWr <br /> APPLICANT NAME C. DEGrooC b Sons SIGNATURE — -✓ ..,__—_:.may <br /> TITLE Partner DRIVER'S LICENSE 9 1 <br /> f,rtoTOOo"are In n Gn <br /> Roam <br /> 9 "d • �Oa� WdLEIE 6661-SZ-eI <br />