Laserfiche WebLink
Jul 30 02 08: 44a 0i el Truck & Equip 20Q-367-1698 p. 2 <br /> 07/26/2002 17:19 2094ru, d AGF STCICKTON PAGE 02 <br /> DATEGREEN FORM <br /> MASTIER FILA RECORD INFORMATION "MFR" <br /> = UNIT 1V <br /> OWNER FILE <br /> COMPLETETNEFOLLowmGQROPERTY OWNER INFORMATION: CNldCKrf OWNER Cueermrrrarr<rrlwrntEMD <br /> PROpERrY Owwa I PHONE S 3 O, 7 5 6 —4 Z Hp <br /> NAME <br /> fool <br /> BUS(NESSNAME am SOtSlC I TAX LO� <br /> l <br /> l <br /> owner HOme Addre99Ih <br /> Q �� �' ^ �l r __ UVERLICE <br /> 'S NSE <br /> tatty ` �V 15 (, T SEAT ZIP <br /> Onnsr Malliltg Adarosa <br /> Ma81ng Address City State Zip <br /> D OF Ow _ _ <br /> CU POILAT1014❑ rUDTYIDUAL❑ PARTNt 9111P O FED AatNc+'❑ On¢R❑ <br /> FACILITY FILER <br /> Rei r I _r R. <br /> COMPLfTF THE fOLLOWTNG BUSINESS 1 FACILITY f SITE INFORMATXON. <br /> t <br /> Is this a NEw Business LocAnoN not previouaty aegulated by the ENvtaoN EWAL NMTH DEPARTMENT7 YES ❑ NO 0 <br /> Is this a.g Exu11NG business LouTtoN but a NEW Tree of regula tel gusist"li? yes ❑ No ❑ J` <br /> Buse,tW FAQLTTY1517E NAME <br /> SITE AOL`RESS serve K HUS]NESS P NE <br /> _ 2 W est L c,c k.eX4 SV NIA <br /> C-,ry L c)61 sTATI � 5z4 o <br /> lig <br /> Mailing Address/rDIFF#RjW ftM)%ddl%ryAddr0" Attention:or Care Of(OAMMA1/) <br /> MagIn9 AddlegS City STATE h! <br /> TNERo PARTY PILLING INFO: Complete If Billing Party &dlf Brent from Property Owner or Facility Operator ident/f/ed above. <br /> BUSINESS MAW tt T 'A rw n,A Attention:arCare Of (Woo""��1 1 �� V� f•�1C�`� C �G. ¶ <br /> Halling Address ? 7S PNONe .2 OQ) 913—3083 <br /> 11 V l <br /> SITAII ^A ZIP �✓�� / _ <br /> AcclBldLlaDBESs for fees and charges OWNER FACILITYISUSINESS THIRD PART'HILLING <br /> JSILLIN(:ANI)CONINJANC[ t,the und.rnST-1 Applicant,:er4(y that I am lite OWitir,Oprralor,orAaihoriced arurr of Chit Suslnas,olid I dOitonted;t that all YewYII-ftES, <br /> FvN v.vrs,ENITIRcrAmvr Gr.it,-Cu nkidlor 1104ARLYCILIRCES Assoc(ared with this nptrstion will be b;Bed to me at the Address ldennfied obvre v the ACCOETEAUttltESf for IMS site I ulso uerit(y 4111 <br /> OR n)(vrmaoon PreYlded In this application is hue and torwt;sed that All regulated dctivides will be performed in Accordaltee with AU applirioie SAN JoAQ(RN COtNTv Ordinance Ludes andlor <br /> .Scandal Js.Ind SrnT£Andlur MUM,1-4w$and PIogvtadop/ As the mJeeAiPtd owner,operator,car agent ul the property Iwai at the above Iscllfy/Sire oddral.I hrrrby aarbatVe the wrose of <br /> say and ad rttulta and t lrironmreht assessment information to SAN JOAQUIN COUNTY ENVIROjt!1NNTAL KRALT)4 DEPART AA loon as N N Available and At 1110 1111110 111110 It It <br /> provid0d to me Sr my rcpraunntirc <br /> PLEASE PRIrn <br /> APPLICANT NAME SIGNATURE <br /> //ee n. DRIVER ENSE IF �r .y' <br /> TITLE h7.1•i�'C/ ra 1 1!`^" (PNoro r REQUAReD) t l ��✓-. <br /> Y, <br /> ,,.• r,,.,,t..,. I I•I;oi I 's' � Ivwt9 o'la I u _ ., .. :� ... <br />