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MRR.30. :5PM CONTINENTAL GRAIN NO.424 P.2 <br /> DF_Te to <br /> T"TER FII.E RECORD IrrFORNLatx "MFR" ",,� • <br /> atru+ao AaPw atm Puu wr nNtr <br /> UNIT N <br /> OWNER FILE tUoot <br /> COMPLETE ME FOMOSYLYG PROPERTY OWNER INFORMATION- CBECA'IF OWNER CORREN u ON FILE ivrm HHD <br /> Property, PNON <br /> Owner Nerve <br /> flu ,err O•r _ <br /> Basttuass NAM¢ (-0. 7 v <br /> c'� L =,f /IIP <br /> Owner$ame AddTcsa .I c�iTE (l C< ORI+tLR's LIW"SE tt <br /> City 'P <br /> rNlc � C-o sYAn /[_ � /ooh I <br /> 0—.es Mwunle Addram <br /> Mailing Addresa City STATE 217 <br /> TyM OF OWNERSHIP I <br /> CORPORATION INDWMUAL Q PARTNERSHIP 0 FED AGENCY 0 OTHM p <br /> O FACILITY FILE Moo I u <br /> COUPZZM TAE FOLLOWING BUSM4M/FACUMT/SrIB INFORMATION.• <br /> Is Us a NEw Bvsysecs CATION not ptev ouely lepUmd by the ENVIRONMEWAL HEALYIi DIVISION? XPS O Not <br /> Is this AN F,ceszwG B LOCATION but a NEW TYPE of mllulated Brumes? YTs p No)f <br /> BUSfNESSFFA TE ale CU A/7//V&A,7 ! G2'�p r, <br /> SITE ADDRESS ` <br /> 9 S ARL gn/ Surm BGSWESS PRONE2e,J qCP& //Z/ <br /> CITY <br /> Fif'E�.c_N l'AmT STATS C,)2 2m 9fZ3% <br /> Midline Addmaa IF DfFFEREA7,Mjnt FdCll/ry Addrrasrfr v.',rJ Dc Attention:or Care Of(nptfnwU <br /> /J", are t ct/A) <br /> MailiDg Address City /.//f Q(" STATE <br /> T*a= PART BILLING IWO: Ca"P/efe fp Billing Patty is different from Property Ornor or Facility Operator EdeaAfrrd above. <br /> BUSNMS NAME <br /> AEontion:or Cate Of(opdnndU <br /> Mailing Address <br /> PHONE <br /> Cir? <br /> STATE ZIP <br /> ACCOVWADDRESS for feu and elmrXes OWNER FAU1177/BUSLNPSS <br /> TIIIRD PAg77 BIII.P.T. <br /> PItLWO AND COljL Aurmw66DO 7,the ureters AppGtant cenify that I are tha Ovaer.Oparinr.or Audlnrliod Agar,of this Euatma.and I dckoowlcdge d»r <br /> all PERV7 FM.PPNAMLI.EWMACEMtM Hornier CuARD£r movated with thil amation will be billed to me at the addraaa Identified above as the Aeeoovr <br /> ADt_�grM for this sits. 7 dao certify that all Ioformatiort prvvdded on tMs apPliodon is true and eorrvr and that aB rtgulucd xdvides will bd performed in secordance with Eli <br /> apPlicable SAN IOACUIN COUNTY Ordnana Cod=and/OT Standards and STATE and/err ROMAL LAWS and Regulations. The undersigoad orntee.operator.or agent of the property <br /> located err the above MdLrylotto Wit%agrees to provide aot7 and groundwater dsra c Netted a put of eovimmomtal tit mm,nts condected at the fucitiry/site to Sin T <br /> Coudty envimamemal Hatm Diviclon m the went the undrrtigned is required to provide such inromatton vhdv Sw Toaquin County Otdits7ns Codes or licy oaquin <br /> of frAcW law. <br /> L3E.v5E PLANT <br /> APPLICANT NAME (, "�Ow�✓ SIGNATURE <br /> TITLE . P, FA(,tc-r?/t,1 DPIVER'SLlaNSB , <br /> •(I' O OCOPY RZOU1,M) C f3 Y 8/"11 <br /> OSH ZO/ZO'd 9YY-1 + ONUS 1I0510yn AMSIIId-MIA W260:60 86-OE-AEN <br />