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• • <br /> San Joaquin County Environmental Health Department <br /> DATE q Z 3 I og MASTER FILE RECORD INFORMATION 1eMFRff GREEN FORM <br /> E� issur owaawo I DAeef UNIT IV <br /> owrleR FILM 5'R a o SS.�6 7 - <br /> COAPEETEIWFOUOWAfOPROPERTYOWNER U TIM sOWNERC pnraNPrtr Nie EHD <br /> PRaPanYDar�tNMR G C L wgrE z <br /> Fhaf Ae Led <br /> Busxess Nees G__Pl, 04 <br /> Q �G Socalc/THIO{ <br /> OAnsr Home Addraem ONVlR'9 Crowle.{ <br /> city <br /> I�A <br /> Y c1,�l� 6 9TAn Z11,DwImrMWgq Addrw T& <br /> :2711 IV <br /> M811finBAddeemi Cay /I / ZIP <br /> /`i0A1VA.aTNIN !!!✓✓✓ MGtAOINI❑ PA1WNEemNIP L� F6PAOxID'/❑ J OTIRA❑ <br /> FACILITY FILE <br /> Lim <br /> IDN Op1PI2 CIIO99Rrf <br /> -oS lfds �AAccautaiDN RPA{ <br /> CCAIPLEwrwFoLLolwAty BUSINESS/FACILITY/SITE/NFoliwvow <br /> Is three NEWBU91fIe98LOCATMnOtPmb [Yr*gUlated by the ENYIROMWOUALNEALTHOEPr.9 YES LT NoFf- <br /> f fs Rtis mf lgRaa�t> enc val6mtaR�n.s�.r ®�defaa�r Vft <br /> BBewe.alFAcmgrrlstreNAeR > C <br /> BnEAextees O Sanas B g e J <br /> -z4 1 <br /> p11' <br /> Q Gf <br /> BOAAoaP9wameoaDlernnrt LcceTONOcoe ReYd NeY1 60 <br /> Mnlllnp AddreaseOIFFERENr Fie e// Atlantlmre tx Cera 0/( N <br /> GD r uM PTS I. <br /> MxFnRAddream Cly / STAn/` LP <br /> 91Ccom APNf Coalttsn: C_ c) <br /> THIRD PARTY BILLING INP01 Complete ifBHling Party is different frumPraperty,Owner orFacllity Operator ldentifed above. <br /> emaheas Neale /�nC ra �G/�/(G� /y }� mr are o1(p>`W,,,Q -1 <br /> Mxllltf AdAaes •)/ �(( /$l^Q // Ve7v-` <br /> Cm iw Ila 5 /.[J SrATe/ m 7Sz�y <br /> AccaverAeer3%98 forfee antic arptle OWNER FAcUW/BUSINESS THIRD PARTY BILLING <br /> RµtLNti ANe CowuANfe ACK,1OWLTRS4RM: [,theendermg.ed ApPlkvnt,certify the l am the Omer,OpereM,orAhOkarimat Ageni of this Beaman,not l achevieci.thestA PUWIrFWE% <br /> PLAnLOPS,6xm.KxuenTCYlAw:6V indlar RavALy CYrtAGSYameaalM wNh this operation wsl be hNM to me n IAe.ddrem Hendsed above a the ALwa.TADpdt'm'far Nb the.lea.a.reray that <br /> .II Iaftem.lbn provided on I1t6 epplkwio.It aee end ceet;end th.t al reg.hlM aOMlin will be perfmmrd to ac<ordantt with vll vppllahle SAN d QUN Cal y Ordinvntt Coda medlar <br /> Slem].M.Yid SYATLenwarFI.MLLew.and Raguktione.A.theuadneignM onnary.,entarangerele po ry locatedet the.beve feffithite add.,I hereby oueheHre theminxof <br /> any.,1 all raxa aid na .atarmmt in/ormaNnn to SAN JOAQUIN COUNTY ENMONMENTAL WAL'IH LUT <br /> ��a <br /> e available u,d at the.ame Ilme It G <br /> I.MM to..or my repremmmive. <br /> APPLICANT <br /> WWNAME <br /> rr ed.A{l.(`�{!��-1 M,, PLeeaepAwr 910NATU E <br /> TRLE III'r-IL,- A%e t Ir`IA, 'Gan Rc1,1.7/rte JUi'PTn? j CRiivrocOnLICENSE0 <br /> n APPravM aY Mle Osk.Ikeaeeal,p comWekd By <br /> z9-02 Id/12N7 <br /> MA5fLft FILE R[CORD43ftEEN <br />