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., eERvlcf itEaueaT '•�,., too <br /> 00A ; <br /> 0 Abrltavla;d i/>tft4f — _ <br /> 1 '.r.t <br /> w RECORD ID 11 j t..rolco N <br /> EA�.1LITt< IDR <br /> Tri Star Homes, LLC <br /> FlAtIL111 NAME RILLINd PARTY Y t <br /> 1325 N. Corral Hollow Rd. I <br /> RITE ADDRESS <br /> I <br /> Tracy, CA 95736 <br /> Ciff CA IIP J <br /> � 1 <br /> r <br /> : .iER/flI'ERAtt)R Tri Star domes 1ILLING PARTY � / N <br /> pNONf 1 9T t51.0 aa-1'460.. ....^... <br /> D9A II. <br /> I <br /> AbDREStt <br /> P.O. Box 1056 PHONE 02 c-f. <br /> CITY Alamo, CA 94507 STATE iPP <br /> sArN # Lend Use Application 1 <br /> . i aoS blot Location Code <br /> u tRActdt and/or �, <br /> =RVICE REaUEStaR Jim Thorpe Oil, Inc• BILLING PARTY Y / <br /> i r <br /> b1A PHONE OM1 �,2.il.Q,.,1_16--.r� <br /> P.O. Box 357 FAX N t :)()gI_3F$_•.185.].. ,..• .. <br /> tittlHa ADDRESS <br /> i <br /> CITY <br /> Lodi, STATE CA IIiP 95241-035`1 ; <br /> LUNG ACKNONLEOGEMENTI 1, the undersigned owner, operator or event of camel, acknowledge that ell site andtnr P4)det epaelfleart � <br /> the ldontIIl*d ae the 111.1.1149 PARTE en �I! <br /> Annim hourly eharves associated with this facility or activity will be blued to party <br /> neve 1 of thle, form. <br /> f i <br /> 4. its* certify that I have prepared this application and that the work to be performed will be done In aceordanee with ell IAN <br /> ioAoUIN WhIFY Ordinance Codes ards, State and F ret laws. j <br /> [LICARI'S SIGNATURE t <br /> .I <br /> Iet Contractor Deter 5/19/97 ' <br /> oollOR12AIlON TO RELEASE (NFORMATIONt In addition to the above, when ap�llcable, I, the owner, operator or ageht of same, of W. <br /> he property located at the above site address hereby authorize the release of any and all results, geotechnical dote and/or <br /> Itorvmntal/site assesRment Information to SAN JOAoUIN COUNIY PU91IC HEALTH SERVICE! ENVIRONNEWAL NEALTN IH WHION ea 600 ee <br /> to AvAllahle and at the acme time It Is provided to me or ay reprementativo. <br /> lure of lervlca Requeatt eerviee Code <br /> i <br /> Asoloned to Employee 0 Date <br /> F <br /> eta Service coTplated / / further Action "beds / N PRWRAM ELEMENt <br /> I <br /> lea Amount Amount Peld Date.of Payment Payment Type Receipt # check ! 106Wly I� <br /> ii <br /> y� Il <br /> E <br /> t <br /> 2H! `/ / SUPV �/ / ACCT 1 / UNIT rel <br />