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JAN. 9.2004 4:48PM TREADWELL & ROLLO FIFTH 5LOOR NO.0413 PAIP.2 az <br /> 01/09/2004 16:39 2E946934,i� 2094683433n pt <br /> San,JOayulCAINgr Wnrrry trlental Health p . AR HFORM <br /> All ' MASTER FILE RECORD TNFORMAnoN "MFR" UNIT IV Cls1 s <br /> OWNBR SDd ' <br /> OW14FRFILF c3lwwOWNER CURAMroPMEd 192M9"P <br /> L <br /> D N <br /> dP EYP PHONE <br /> KFOYOWWRNrdad Lair <br /> Pw Mi <br /> /� ° SocAYIT�Y07M <br /> pWe5fNPM1 / �r {'i�Pr 1n . <br /> rrerflome Add[e1s 0 <br /> n � � <br /> vicar M211112 AMM" g ZIP, <br /> allinaAddmPsLItr Com, <br /> �' fsnAcacrCJ rnw1❑ <br /> CaN+oRArtdx Q <br /> yrnrnowu❑ PuYxwdx,aCl <br /> IrAGLITY FILK <br /> 'zriYas <br /> Balm ID'ir Cndss FEF70 Jf <br /> AcalalPfnxo a <br /> :s 4115 a <br /> RTM�Mfd Yea N0 <br /> Nw Business LOCATION not pWiNIU51V regulated by th,ENyreONMENTALHEAI-TN GF7aA � <br /> YEA � Na I7 <br /> s this an P?OsrzNP BUSlnesis LocnTmn but a plewTYPE of elated Business'+ <br /> susTlsts/P■a1mrJ�rENwe gusatrr WuxrrsPRoxE <br /> qrm Aoose95 $fAIE zip <br /> S o CA <br /> SWBRD PF Syp0rd7SPRD{171� <br /> LdGTWN re01 7 q3s�d <br /> rLZ03 <br /> ^ �m Offa <br /> raang Addna mFsd4 eofi r <br /> SA1d— <br /> meninp Addrencity �Gn t'i'Gin ciSto <br /> /J+N AF CPMMBHI'[ <br /> 9IC'Cou4 <br /> Cpmp/ex.Ir'llingpaRY is;6fferentfrornpropurWcnarorFaeility Perlde <br /> atorldttWabare' <br /> WIND PARTY BILLING INFO: ///� ,• tioR7 or Of (opt wao) <br /> a,�ssgpLwe �r C <br /> PIax1 <br /> Mail"mg Address OmP <br /> cm � ��ryG/lav <br /> iftp <br /> forfenandchargaf OWN[R FACILITY1BUSIN¢� <br /> T}IIRD PARTY BILLING <br /> pla <br /> [[[he ondenlgaN APPliton4 rerdty amt 1 am we aw ,Oj'11-11 BrAuwPrrsef,Yfar sf Ihll budnV Bed I ardo[rft ris111 that PII COW CAM an <br /> uatYCllARc[SBlmaabad' rh rNr°peradon wlg 4r 6illadmRe of the aJdrw IdePdEeC <br /> aeon a1dwA=2L erfa ForOU TY ala1mle COW thrall <br /> :NALTIf5.1SMFeFcdMl;NrCN-utCdr andror HP <br /> VR <br /> arra Rlodadona. As the andmigned aWawr.m,worr,4Y Kcnt or IRB Prspnq'Ioalpd At dR 11)"b ai9Ydqqw Bddrpa�f Vete. a at the 011n timetI Of <br /> [etRlalan pr°vldrd on d1le aPP^CaPbn H wa and eano°r Aad tboe dl raCulPW aedddll M'II ha Mrf°r Red III Krord?AL1 4ddl 1P PP 1,9°��f�ONN COUNTY OIdI11PYr MAP Or <br /> Andarda and SVTs nndlPr FkDsa+� ��'r <br /> iI and an rllstp E A alniMPTen L LaatslReor IPfOmnd°n m SAN•10.QUIN COUNTY MVMNMVNTAL ReALTn Q ? 10On I[ .1_ and at NB umr time It Is <br /> dW to me or mY nplesfy °r) \/* �,7�f� KcF Pinar 114NATORE <br /> APPLICANT NAME W 1)! �J�" pR=yER"�,LrtlN9R7F . <br /> 1111E PRmomM'FlauPua) _ <br /> I`r✓r C-t C � eatr <br /> pPplornd BY <br /> Pelf , aundna OlfiaG pm im;rA,gpkcWFY <br /> i.Py-QD2 A9n12S,2Z , <br />