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0 <br /> San .Joaquin County Environmental Health Department <br /> EE » GREEN FORM <br /> DATE I,1�tl I tt MASTER FILE RECORD INFORMATION MFR SITE MITIGATION& LOP <br /> UNIT IV <br /> c A-liAlIFOR <br /> END USE ONLY OWNER IDN <br /> rawHeeWmT EHD <br /> _rC4_ <br /> . erry an Ins � <br /> OWNER FILE:2�)MPLEOETHEF0Y. IDWINGl PROPERTY OWNER MFORMAMON: WC.., ER1.(209)599-3035 2.(209)599-2108 <br /> pacpsirrowNERNAME 2. Ci of Ri on i f 1 n <br /> First MI Lest PNONENUMaet <br /> E-MNL AODMEss <br /> BuaNEaeNArE 1.Ripon Milling inc. 1. info@dendulkpoultry.com <br /> e <br /> Encroachment Permit obtained) <br /> Damage Hone Addn p <br /> ///���/ ��J /iris aTATs Z• <br /> city J"/�'7� (n i'l' I///(/ <br /> (lyrJ�r v C% O.Box 180 <br /> Dwner Mailing Addl <br /> state 1.CA Z 1.95368-2745 <br /> Maiung Address cltl 2 CA 2 95366 <br /> OOflPOMTI N G INONIQUAL❑ <br /> PARTNEASHW❑ FED AGENCY 1:1 OTHER® <br /> SITE MITIGATION_ENYIROMM[NTAL AssEssMEITT X VOLUNTARY CLEANUP_WATER QUALITY_NW PIPELINE INVEl "TION_LOP <br /> FActuTYlDtl INvN0 ROO A <br /> E LEAD AGENCY:EHD_RWDCB_DTSC._EPA_ <br /> lL- t <br /> FACILITYFILE CbMPLECETHEFOEIL BUSINESS/FACILITY/SITE INFORMATION: <br /> Is this a NEW Business LOCATION not previously regulated by the ENVIRONMENTAL HEALTH DEPARTMENT? ❑❑ NNCD <br /> is this an GUSTING Business LOCATION but NEW TYPE of regulated Business? <br /> Yes BIISINE99IFACILm'/SR£NAME Business:Nestle USA, Inc. Facility: Former Nestle USA,Inc.Facility <br /> BUITER BUNNE99 PHONE <br /> SITE ADDRES6818 549-6000 <br /> 230 Industrial Avenue <br /> STATE Zee <br /> Cm Ripon CA 95366 <br /> BOARD OF SUPERVISOR DIHTRIG <br /> LOCATION CODE KEYi KEY2 <br /> Attention:arcare Of(cPa6nslp <br /> 800 North Brand Blvd <br /> Meiling Addraend RENT ftotnFaciplyAdtlMichael Desso <br /> 800 <br /> STATE Zip <br /> MalangA Basicity Glendale CA 91203 <br /> sic E APN s COMMENT: <br /> THIRD ARTY BILLING/NPD: Complete if Billing Party is different from Property Owner or Facility Operator identified 40ve. <br /> Attention:OrCam Of(uptiblse/j <br /> BUmNE AME <br /> PHONE <br /> Meiling Addre <br /> BY ZIP <br /> Cm <br /> AccoUNTAOMM for fees and chargee <br /> OWNER FACIU BUSINESS THIRD PARTY BILLING <br /> rT iCANONLfOGHE9li <br /> ],the Undersigned Applicant,Fenny that I am the(honer,Opemle or Avooniced ARenl of thH Nasions,and I acknowledge that all PERVNFEES, <br /> YesatnEs,En'I'oRCEnIE,vT Ousnfs nntl/or NOCRL I'(osR.E5 msadatrd with(his operation will be tallied tome at the address Identified above At the ACTOUATADRRESS far this site. i also certify that <br /> all Information provided on this application o Rre and canto;and that ail regulated activities will be performed In accordance with all applicable S,,JOAOfIN COUNTY Ordinance Codes smaller <br /> Standards end ST.ovi and/or FE-PIli Laws anti Neguletions. As the uatlenlgntrl owner.operator,or ascot of the property located at the above facility/die address.I hereby oath art c the release of <br /> any and all results and environmental anessment Information to SAN JOAQUIN COUNTY ENvIRON%tENTAI, <br /> HEALTH DEPARTMENT m soon-sit b available and a(16e same time it is <br /> provided tome or my repmentative. <br /> APPLICANT NAME(PLEAEEPRINT( Michael Desso SIGN TMRE <br /> TITLE Director, SHE 7Ax to# Federal ID#95-1572209 <br /> ---------------------- <br /> FFsE: <br /> e Y <br /> Date Accounths (MloeProcessing Completed By DW ' <br /> GATION AMOUNT PAID DATE OF PAYMENT PAYMENT TYPE RECEIPTM CHECKM REcervm lr TyopK PIAN PE <br /> ag�� <br />