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UPG �C� OML�D <br /> SEP 1 0 2009 <br /> San ,Joaquin County Environmental Health Department NVIRONMENT HEALTH <br /> PERMIT/SERVICES <br /> DATE MASTER FILE RECORD INFORMATION "MFR" GREEN FORM I <br /> $Nd#EPAtlEde waEHp yeE DRy. DwRERID0 f <br /> CASE* UNIT IV k <br /> OWNER FILE <br /> C0MPtE7E7HEFML0W/NGPROPERTY OWNER/NFORMA770N.' CneorTF OWNER CuxxExrt roxntewnx ENDO <br /> PIroPERrYowtmtNM1E _ S - 3S <br /> PHoxE <br /> Fra} MI [eM <br /> SMUNESS NAME San Joaquin Delta College <br /> hoc SECITAa1D# <br /> Canner Home Addrue 5151 Pacific Avenue r DRNER's LN1TnE# <br /> CNy Stockton /„_ gTA7E CA Lr 95207 <br /> owner McYlrg AWrae I.IHHiW' <br /> Mallblp Address City 9hb ZIP <br /> CORPOR,tTgNO INteV1BUIL❑ PARINFABHn❑ FEBA4Er1Ly❑ OmER❑ <br /> FACILITY FILE <br /> FAeaurvlDs CnOss REFID# AelwuNr lD# INy# <br /> COWIE7E 7HEMUGH NG BUSINESS/FACILITY I SITE/NFoRA&477oN. <br /> f Is Mis a NEW Business LDCAnINT not prevlousy regulated by the ENVIRONMENTAL HE Em DEPT.? <br /> YES ❑ No <br /> Is this an EXISTING Business LOCATION but a NMTYPE of regulated Business? YES ❑ No <br /> k <br /> BUNNEea/FactunYetrE NAME San Joaquin Delta College: Agricultural and Natural Resource Yard/Shims Center <br /> SITEAOUR6BS 5151 Pacific Avenue - Surtr* Suzanne PHONE <br /> Ctrr Stockton STATE CA ZIP 95207 I <br /> I <br /> BwRDOFeuPEml9oRasrRlcr LOCATpNGooE NEY1 NET$ <br /> Meehg Address raFFmevrlpYrT FeoNyAd6m AlbalMon:ar CarsofftalliplI'r <br /> MaBing Aadreee City <br /> STATE 2w <br /> SIC DOM APN0 a D/ CaMNaa: <br /> THIRD PARTT BILLING INFO: Complete#Billing Party is diA'erent frornProperty Owner or Facility Operator idenfifiedabove. <br /> BuNNesBNaRE <br /> MaMlg Atltlrean <br /> Cm _ STATE LrIS �.. <br /> I <br /> ACCWArLADOHE5.4 for fees and charges OWNER FACILrrY/BUSINESS THIRD PARTY BALING 1 <br /> RILIJNG AND COMPLIANCE AMNOWLEOGNrxr: 1,Me under pM Appltant,eddy that r am the ONYer,Opemmr,or AWk.*ed Apert!ar nus costae,and I arhoowkdge dut au PrnNTr FEhi', <br /> PBw[nEJ.£rvFlixrt v£M'Ciuxcta asNornOurarhTepGFs assodated with Wis openuan oJu w Wed to aleat Weaddrea WaS,,r4 above as Me Accu A for M6dtn Iabo.rury Wal <br /> W informauoo provided on Mb appliauon b une and<orrtet;end Wet all regulated eeuWtles wd0 be performed is aceardaa IfeaNe SAn JOA LbumT Ordioaa Coda aed/or <br /> Sbnd.Ads and STATE and/or PEDERAJ.Laws and RegWaWr A.Aa Me undersigned owner,ollvetor,or agent of We Property OM • adli h dd hereby eaMPrbe Wr relase of <br /> any and AU reonle,and amroomeoul assessment inlarmouan b SAN JOAQUIN COUNTY EN VDtONMEWAL IIEAL DEP/iR NT ss n it e a Ilabue and at the ame ume tt b <br /> provided M me or mY reprwabuv� ' <br /> APPLICANT NAME !� Y /(�" dV` PtrweE PRlert SIGNATURE <br /> TITLE DRIVER'S LICENSE# <br /> IMIOTOCOPY REQUIRED) <br /> I <br /> Appeved BY eeb � ; PoeamD OMca PreoesehN cuDPlerd BY F IMOe <br /> 29-02 10/12/07 R?t MASTER FILL EECORI}OREEN I <br />