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j 07/06/2006 14:54 NEW l* PETROLEUM 4 12094683433 � NO.190 P002 <br /> San Joaquin County Environmental Health Department GREEN FORM <br /> 6 ""' 01' <br /> DATE O �o MASTER LINFORMATION E RECORD 1% if <br /> _.� 5ui��dl <br /> OWNER FILE <br /> QIEQrID OWNER NRREN7zYOM/J2E irprx EHD <br /> C0NPU7F7NEf0LL0WRW OPE W ER IniFOReurronr1 <br /> FwrmTrovmfnNala yj-rn. <br /> poor-,—,,' <br /> Flrat MI Last <br /> SDCSEC/TAIDR <br /> R=Nm NAME <br /> _ Owner Home Address mot,Q <br /> STATE 'zw <br /> city C 1 fin <br /> owner Mairing Addrook <br /> MBIDIIg MdreSs rill l 9rere pP�S D <br /> CSC; Lt fYl l N1 <br /> -- - --- [lIDarIDslx. -- — A PARrNerww❑ g�A6nN.[❑ Ors+at� <br /> 00 �I� �y'7'} 1, ICAC �., 5 Orli r./ GLI7YFILE ,..'., i rul3 L�bl � RIr'au� 5 "EM <br /> .ii122 <br /> 7mra <br /> i M N <br /> Ts this a NEW BueineSS LoCAnoN not previously reguhited aP tlFe ENYIRONMENrAL HEALFN DEPARTMENT? YEB ❑ ND ❑ <br /> Is chis an E%ISTINc BII8ine55 LOCATION huf aNEW TYPE of regulated BusinesST <br /> YEB ❑ No El <br /> ! &19I✓6'iI FAERIIY/Bare NAlrE I!/1 CI J elk 4-101101 <br /> '^ SvrtEA` sew/ PHONE <br /> STM <br /> cbvI rYl l l _;';i <br /> I$�b NF.?n ,IP � :y� uGpl <br /> [; <br /> aNeirdon: r ire or(oprwna4 <br /> dre d9�s <br /> iy !7f- <br /> S-ATE 0-, ZIP � <br /> NaIIM+g AddrEpcM ,I f,� <br /> SAL4 7✓(I ✓l !jp <br /> �• i, " .Y� ' ' I ml r1 1M6 j y '�„ i i ,a M 'i s ,125NP-'" U� •Fil ')'LYr}� ak v^I&4. 513�,' <br /> t 41 .� r ; r, M `"' M'[;I,/9 ryUi ly sjl Iras•rejw„I ii" YII� <br /> Com lets/f Eiiiii Fa is ddfetentfmfn Propeft Owner trFMIEty uperator/deiWedabove. <br /> THIKU PARTr BiLUNO INFO; A AUVRE11n gra ssor lnatlasan <br /> Bpsa35NAl� - <br /> PBC ._ <br /> Mailing Adding¢ - <br /> STATE <br /> ';SF for fees and Ctlatge5 OWNER FAOILITYIBUSINESS TNIRDIART-DILLWo <br /> .�v,r,�aMo Ime vntleni dA IIwn4¢rd%Ohmlam the Amer,pperdor,or AMlPortardAgcnrIf'his EQdPM,and l vtknowdedle bet all Pe F)FtL <br /> gne pP for Ohio site l dso¢rtdy that <br /> ParE1LlP.5,ENFORCGRwrCXMG�endler AOIWYCIA &-M-6sed with this operation will be billed to me at the address Identified 000ee�me <br /> �awYY Ord'mvn¢Codes.'"'for <br /> vll information PMdad ad this applimdoo is trve sed¢fret[;sad¢hal all,sod old activi[icf w111 M p t Ofthe in attot Waled cat d above mbdllay s ad�CI hereby amhori"the rebse of <br /> Standarm and SLnAanis/orF"B jawsand Ragalvtiodf Arthe undersigned owner,opy EN oragentofrhe Property <br /> Z ed all reaulb and eneimtmlenixt usmment information b SAN JOAQUIN C0a1NTY ENYIRONBffNTAL asp,LTH DF'. n availableat wme d _ <br /> rovidd to me or my representodYe.` PIUNT <br /> SISNANRE /('/�4s�ay7w'”/- <br /> APPUCANTNAME <br /> TITLE DP1VeX07000or FPS LICENSE <br /> 7 <br /> "V.,By t <br /> AOooultdrg Dllloa prateWM9 Completed gY :It:ft <br /> 29-02802 April 25,2003 <br />