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_ San Joaquin County Environmental Health Department <br /> DATE q 23 D}3 MASTER FILE RECORD INFORMATION "MFR"_ OREENFORM <br /> W51,43 °A°B# 1 UNIT IV <br /> OYFIIEN FILE <br /> COMPLETE rHEFOLLOWWOPROPERTYOWNER/NFORFAnw.• CxPeAr 'OWNER CURA aYMFAVK EHO <br /> P.opDDNowWeA HAxe � C` ---- 1 alt»,E z � <br /> First MI LaY <br /> BWNEUNAAEG SMUCITANIe# <br /> Owner Horne AddrenaJo �IMEr rl C�1'Qh,CG••�y/[�� DpeEA'e LtcplsB4 <br /> I Li C 6-3 e%[� BTAiB LP <br /> Dwnerwllhq Mdrun y// <br /> lualling Addeeea City /✓�.( �/ ( amu% 2tP ✓s�U7 <br /> c°nP°AATara havicuu❑ PunxESeaP❑ FwA.woY❑ onanD <br /> FACILITY FILE <br /> fAcnm lD# ��0019�D5� CNoes Rer lD# AecaurRlD# , two <br /> COMPLEFrHEPOLLowrNO BUSINESS I FACILITY/SITE/NFORAwnav W <br /> Is this a NEW Busllress LOCATION not previously regulated by the BMROMJERTALHFALTRDEPr.7 YES DT No V— <br /> @Dl¢�rE±�raac�sfinestncvea&da�a_TfeEnf®mr�hdPn�essP ttr�Ntr�[ <br /> BUBWE99IF.KILRYfe°FNAYE a G' <br /> SmAaoNEBs O Surra# BumxEse 7 _29 <br /> e <br /> CRY 7� STATE 2W <br /> 9OAAaar 9urmweoRDtsmtcr L°CATgMCooE Krrt KEr2 r� <br /> Melling Addree.ffD/TENJLM FuMtyA/ AgeMlon:w Cara Or= <br /> I l� <br /> B ,�fen'7)ipr _S"euin Cl`S I <br /> M.mngaddr.n CNy / BTATE r— 2+n "J Z D <br /> slecw °x <br /> i APN# CaExr: / [ W <br /> THUD PARTY lluLuNe lhu of Complete iJBilling Party is different from Property Owner or-Facility Operator identifedabove. (� <br /> B°YNESS NAME 4 1*4 ! _1_ i (L Absentees:°rCereOf(Robsonwll `e <br /> r ngAddeL � _. PAM.Ili72I A) / 7 <br /> Cm srAte,-.11 2r 7.SzD/ 1 <br /> MR,�Da4699 <br /> for fees and charges, OWNER FACILITY/BUSINESS TMRO PARTY BLuth; <br /> BRJoic ANp CUMputANCE ACTIN lilatderT[: 1,the mndnelged Apparent,certify that I Am do,eTmer,Operefor,or ANNo/$ed Agent of this Bmalnen,and 1aeluawkdfw that all PsdumrFers, <br /> PF.NALns$5rvmMAMPNTGrAA(£a molter 00r,er CJu T auemied wish this operation will be biBM to on at the address idemsed above ash the AC�TArtonsa refthualit ttiroeerilythe <br /> all 1.1co.tbn provld<d on thin applrmtbn b true and coarsest;and that dl replaMl aelidli. IN her p ssfarmd 1.ax orda°re wilt,dl nppllable SAN JOAQNN COMY Olds naoar Cada and/ar <br /> Standards and STATE And/orb ala Laws and RKnlaliona.An the undenagneI owner,operslay or agent ofthe property lowered at theabove fadlityhtte Address,l Nerahy authorise the release of <br /> any and All cream and environmental assessment information to SAN JOAQUIN COUNTY ENVIRONMENTAL. <br /> provided ny repressntetive. <br /> WRgETAaC0IW E <br /> �T" available,And at the same time h u <br /> to meor <br /> APPLICANT NAME pepn SI <br /> O0TITLE y < { A66,?4 MQyzag� <br /> nEau REQ <br /> Apprwad BY pee AccaMW.INeae Prmaeed C gy —.—__ Owle <br /> 29-02 10AY07 MASTSK a1LC RECORD-0N?CN <br />