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San Joaquin County Environmental Health Department <br /> DAZEGREEN FORM <br /> 08-30-10 MASTER FILE RECORD INFORMATION "MFR" <br /> QN ERRIOi Csvr0 UNIT IV <br /> OWNER FILE <br /> COMPLETE THEFOLLOWNGPROPERTY OWNER INFORMATION' Ciez OWNER cumee yuxnte EHD <br /> FaoromQVNDiNUE e t>.,aee 714-590-8245 <br /> Fv ut Lear <br /> B�NAne Frontier Transportation Inc. SOCSDC/TmlD# 94 1685428 <br /> Ow Hm AddDRNUeUJ f <br /> city Srwre b <br /> omivr Mamas Addinrf 3577 West Phildel hia <br /> rastngndaro'ecay Chino Side CA 24 91710 <br /> OOSPURLiv1N® Iromaw.❑ PA D FmAcr 0 oma❑ <br /> FAenUW FILE <br /> FwaunlDi cSom Ru IDC A=aa (DC IND <br /> COMPLETE THF FOLLowvG BUSINESS I FAC ILITY/SITE INFORMA nom <br /> is this a NE Business LOCATION notprevloti'ly regtiatad by the Emn MLmru HP 71H DEPr.7 WS ❑ NO <br /> Is this w Fmx7YIa Fkssk aALocA7iDN Dui a NEWTfw ofreadated Buainess? yea ❑ Pb FQ <br /> AOAN f ma"""r Frontier Transportation Inc. <br /> 425 Larch Road 3, 0 209436-0251 <br /> O] Tracy STAT CA b 95376 <br /> Ua OFSUPFAVIewtDnTtlCr LOCALImcom - KM IrE'rz <br /> MW"Addroa ClNFTER9JTAoarF*mWAdbses Adwilm:w owe Of(op6boV <br /> MbftQAdlkV&SCRY STAt zr <br /> slccoC APNC Coaaeal; <br /> THIRD PARTY BILLING INFO Complete A8illing Party is different from Property Owner or Facility Operator/den6hedebove. <br /> RADONlaa afCa OF(gWau� Lar Witwer <br /> ve.t�srNMe Ami Adini &Associates, Inc. Larry <br /> Addf0e4609 Russell Avenue P" (323) 913-4073 <br /> arr Los Angeles =A" CA LF 90027 <br /> AwavaTAm for Fess end ahfsyos OWNER FACIITYISUSHMS THem Pum BIWNG <br /> BiLW ne AND CAnwunrvct ACwlowunerarT: ;wetmCenlgved Apptfe�aatlr7tldlvm me Onnri,Opeavbw orAdaorael ASrfRot blf Bavlvef;avdI a6mowlatlga batdlswaartsat <br /> Ax4[rrF{fMOrc�'ICh+Bta and/orHoneerOyawr�'atodated n'h Db apetvtlm wa hbFkdb ox 2ih addrtaf ldevfLDed abmemthe A(cUTr+rAnnerie lm bh doe.Idw artly lh3 <br /> aO lotofmtlov pmNam at/Mf appudfov h tans atl m+rb>;avd that o•regaiyM ndlhdn MI M peafoamee W attvdaae whh m epparatle SAV JrrAQuw CCumT Ottaaav[t bdn evYor <br /> Smvaarm ava Srwrz evd/or FEvrxu.Lam anAReadatlom.Af mewhntgnea owner,opertor,arvgrt al be Pa¢ea(ybUedal beaLOTeradlly/Att adbailbutlry aibodfebe Rlraeer <br /> any etW o0 avarb em evNaovmental awamert Ivformafbn to SAN JDAQU[Ci COIRYI'Y FIWDiONA4:Nl'AL HF:AI.TH DEY�AR{�T'AgNi a foot/a ah w�djflabie avd a1 the acme tlme'h <br /> pmNeedto ae or tvy rrpme>Qaiha prPawr i..2.. �\ ice' <br /> APPLICANTNAME Larry Witwer, Ami Adini & Associates, Inc. SIGNATURE <br /> DPo4ER'SL10EME1 <br /> TITLE Sr. Project Manager(Authorized Agent for Owner) <br /> Ap,xv By Dam AemurtiM OtlYv d tom. <br /> n-0 INILa/ htA.STFRP[I.E RFLORD{+RIDJ <br />