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11-17-1999 3:39PN1 FROM p 2 <br /> SERWEREQUEST <br /> Type of Business or Property FAC1LlTY IQ# WFMCE REQUEST# <br /> GASOLINE <br /> i <br /> OwNERI OPERATOR SLUNG PAM C <br /> MASON CENTER LLC <br /> FACUTY NAME <br /> MASON CENTER <br /> SrmA=ms <br /> 6425 sa.«aanE. o .oc. PACIFIC sawaam. E , <br /> ftftg AddTass (0 Q'Aserent tram Site m6ress) <br /> CITY STATE Me <br /> PNONE#t Fxr. APN# LANo USE APPtt-ATtaN# <br /> PxCNE#2 �+' 80S DmsTarci LOCATION COM . <br /> CONTRACTOR t SERWE REQUESTOR <br /> REQUEMR BLUNG PARTY* <br /> LF,LAND YIALELIS <br /> BUSINESS NA.YE PNaNE# Fxr. <br /> W.A. CRAIG INC 7 693-2929 <br /> goo <br /> Mama 6940 TREMONT RD F� 693-2922 <br /> Cm DIXON STATE CA Zm 95620 <br /> BILLING ACKNOWL.EOG,gM£Nr: I,the undersigned property or business owner,operator or auttwrhod agent of same adaiaMedge that alt ads w4for project spec9c <br /> PUSUCHEALTM SExVEM&mKM EM HEALTH OMMW rQUfty tnaiges as d van MTs pmotor amvdy rAp be billadtD aN or my business as iderrt6ed on ARtaan. <br /> I also ce;*#Z I haw:prepared this applkAW and that Ere wotlt to be performed wil be done in ao:xxdance wdh ea SAN JOAam Cour Oj L anee codes,Standards.STATE and <br /> APPOCANT SMATURE' GATE' <br /> PRWMTYIBUSNM30WNM C OP"TOR I Maxpr>EA Q OrAnAAuwRmmAmrr 0 <br /> mraPPes A;nest ea[#cPwv.pNdara#eIOIRtd#n M nign& wb d rift# -- <br /> AUTHORIZATION TO IREUMP WWORMASM Wows AppG bla.L the owrm ra operatna ef the property boated at Ere above sae address.herehy aVbXtas 10 reieP-A of <br /> drry and at results.gemctmicah data arcuar efmWmnmenbYsita assessment jakmeamr b the Sm JQAQMf Co am Pusuc WJL7x SERYcEs ENv1R NWITAL f MUH ONSON as 5nefm <br /> as d is avadabie and at the same tithe itis provided b me of my Movetentadve. <br /> TypEOFSERVICE REtluESTEG: CONSULTATION SITE VISIT <br /> CtearENrs: <br /> t7sA` ECTOR's SicxAruRE CaKFACTO%s 515nATUxE: <br /> Appwvi o ay. I y`F.R: DATE <br /> Aaw.mmm; EIWI.tlYEE#: DACE: <br /> Date Servka CompkW (ff ahvzx;y cungAidied): se"%eCOom RIE:. <br /> Fee Amount- � Amount Paid Payment Date <br /> PayrneatTypie !noise 0 Cheek# Recenond By! <br />