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y ' _ JJJ G GJFI'I k-Uly i 1iNtn i HL �KH1N NO.424 P.2 <br /> D MASTER FILE RECORD IwFop,r�AzrON "MFR <br /> �H,.z+ea AaFw x*v►w uzs a , - - . <br /> UrI T IV <br /> OWNER FII. <br /> COMPLETE TXB FOLLOWING PROPERTY OW QR INFORW rj01K <br /> C at W OWNER CVkRENM ON FILE IMN MW C <br /> Property <br /> Owner Nattre PHON <br /> rim �r— <br /> lav <br /> BL'smm NAItiM <br /> O ..T •��=^i?q c_ �=� , CL^/I1:Vin. Soc xcrrAx MrG.� <br /> Ovnet Home Addr�e �j���7 E //C<; <br /> a <br /> tv Dltlnx'S Liam tf <br /> O"Ces Mailing Addram /L 0 <br /> �AMz <br /> Mailing Address City <br /> STAN rp <br /> TYPE OF Owr4m SP <br /> FCOZORAMON14 INDrMVAL O PARTNBRWIP D <br /> F�M AUNCY❑ OTBU p <br /> FA CII.ITY FILE Al PA 15'�Q <br /> COMPIFJF THE FOLLOWING BUSINESS/FAaLrry/SUE ZNFORdfAnoK.• <br /> [It <br /> Us a N .rwt; previouslyEw BUSS LoeAT=4 act previously reg+L=d by the E.YVIRtilom4iwTAl; ALTH Dlvrsmr4? <br /> YES O No)c <br /> this AN Etlsrnve BUse4ws LOCATION but a NEw TYP13 of tegWeed,Easiness'. <br /> 1'z3 p No k I <br /> BUSmBSS/FAC=Y/SLYSNAME <br /> SrrP ADDRESS ^, v <br /> d C Surm# BUSINWS PROs 2.0 qe6 <br /> a"` <br /> STATU C�Q mp ?Sa 2s <br /> Mailing Addrem 1F DIFFERL•NT,fs•ars FuCU/ryAddtt!,rs Z { <br /> Attea4oa or Ctire Of(nptiasaq /jr• 'a�P d c.(/n/ <br /> Mailing Address City N c G r <br /> ZIP C U F <br /> Tam PAR-yy BILLM IWO: Comp/efe Ef Billing Party is ditreatCrone Property Owner or Fad Uty Operator idenWwd above. <br /> BURNIM NAME <br /> A&ntion:or Cate Of(apriana� <br /> Mailing Address <br /> Cttti PHONE <br /> STA7E zp <br /> ACCOUNfADDAEST for fc=and charM 0-mm <br /> PAC11Ir7/HUS2YPSS I1-IIRD PART7 BIIS.7•'C <br /> I <br /> BIu tT±o AND CO►fpt LUV At7c?sowLS=mENi I.the undersipcd APpliant cMify that 1 arc the Ower.Opsnrur.or Aurlw�rLted Agcnr of this Bminoas sad I aekao_lcdse that <br /> sll ikm f PSSa.sit& I7la car17RC6hat d��antUor former C/fAw-u aetociated w�dhiv apasdon will be bdled to nae a the addewe idestificd sbovc of die Aeeotwr <br /> a p applicable <br /> for this Trite 7 O c y Ori)p lag all io d,, tion providcd On this appli=ion is true sad:mrex and that all Mgultucd scavitie4 Will be pedhrrncd in accordance with SU <br /> applicable SAH 7o;Ae Nc Hry/sU Y Ordlaana Codes and/pf Snndards and STATE and/or FEDMLAL Lays sad Regulations The undersigned anter,cp==r. or agent of the propmy <br /> located u the above titeility/site addraee agtaus to provide soil 2nd �oundvatcr data calleeLLd as pRtt of eavimrunmmtal yctessroeDts :ondncteS <br /> Couaty finvirvnraemal Health dlvlclon to the Nuent the undersigped is tegulrld to provide such infomytlon under Soo 7aaquin County 0tdim'ed at the fuciliry/sib t7oagttia <br /> Codes o►state of fcdctal <br /> San an lay. <br /> APPLICANT NAME PLs uII ftNT <br /> C /'0 c,,n/ SIGNATURE OW 444^,_ <br /> TrILE , P. FA L f i-tl F j DRUM'S LICENSE* p <br /> (PHmvcovr xm)l PD) <br /> 051-4 ZO/ZO d 91►>r-1 + Uins NOSIOrMI A8t195111d-��d 60 60 88-OE-�EM�{-��j�� <br />