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b ..go...:.....::: .... l.b Sam JQaElul .:. <:::::::>;'u� E'fe i .:: rvice E r a .::.::: : ; v DATE 11/05/99 MASTER FILE RECORD INFORMATION FORM {EH 00 1 S(REvrsED 06H 1197} . : SMAt�tAMZFON HDO• UNIT IV OWWR FILE COMPLETETHEFOLLOWINGBUSINESS OWNER INFOR)WATION: CHECKIF OWNER CURRENTLYONF/LEW/rHEHD .................................................................................................................................................................................... ..... -----................------------...................................................... BUSINESS Robert C. Warren II PHONE (714) 708-0180 OWNER NAME ------------ ----------- .-----'..First.............. .... ........................................Last.................................. -. _ il,R , SOC SEC/TAx ID# BusltwNpM (If ddferent fromOwneNat�tte) Investors Property Services OWNER rHOME ADDRESS .•�� DRIVER'S LICENSE# NOV City STATE ZIP ,i OWNER"jWI Ess '(if0/FFER0VTfromOwnet-Address) 2651 Hotel Terrace Attention:or Care of (op6ona/) Mailing Address City Santa Ana State CA zip 92705 CORPORATION❑ INDIVIDUAL❑ PARTNERSHIP❑ LOCAL AGENCY❑ COUNTY AGENCY❑ STATE AGENCY❑ FED AGENCY❑ OTHER� FACILITY FILE ;;::; :::.:: : . ;: AEtCif1�'# # `.": COMPLETE THE FOLLOiiAvINU BUSINESS / FACILITY / SITE INFoRMATiON: Is this a NEW Business LOCATION not previously regulated by the ENVIRONMENTAL HEALTH DIVISION? YES XX NO ❑ Is this an EXISTING Business LOCATION but a NEW TYPE of regulated Business? YES ❑ No ❑ BUSINESS/FACILITY/SITE NAME Larkspur Estates Tract 2675 SITE ADDRESS Mac Arthur Drive SUITE# BUSINESS PHONE CITY Tracy STATE CA zip 95376 Mailing Address ifDIFFERENTfrom Faci/ilyAddress 1620 N Carpenter Rd., Attention:or Care of(optional) Suite B-1 John Zellhoefer Mailing Address City Modesto STATE CA zip 95351 «.. ...................'. ` .; ; .SS ` . THIRD PARTY BILLING INFORMATION: Complete if Billing Party is different from Business Owner Identified above. -----..... .............................•-------...................................--•-•-.................------............................................------•-----•--.............................--.........................---------------.................................................., BUSINESS NAME Bright Development Attention:or Care Of (optional) John Zellhoefer Mailing Address 1 620 N Carpenter Rd., Suite B-1 PHONE (209) 526-8242 CITY Modesto STATE ~IJP--4a3 \ ACOlffiMAODRESS for fees and charges OWNER FACILITY/BUSINESS ( THIRD PARTY BILLING) BILLLNG A.VD COMPLIANCE ACICIOWLEDGMENT: I,the undersigned.-Applicant,certify that I am the Ownex,Operator,or.-irtboti;` en!of this Business,and I aaO*wledge that all PERAttr FEES, PENALITES, E.VFORCEAIENT CHARGES and/or If06RLY CHARGES associated with this operation will be billed to me he address identified leo' a as the.-ICCOUNT .ADDRESS for this site. I also certifv that all information provided on this application is true and correct: and that all regulated activities wilf-fie-performed in accordance with all applicable SAN JOAQUt`COUNTY Ordinance Codes and/or Standards and STATE and/or FEDERAL Laws and Regulations. As the undersigned owner,operator,or agent of the property located at the above facility/site address. I hereby authorize the release of any and all results and environmental assessment information to SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION as soon as it is available and at the same time it is provided to me or my representative PLEASE PRINT APPLICANT NAME Donald E. Reed SIGNATURE TITLE Vice President/General Manager DRIVER'S LICENSE# , 3 Approved 8y a A60oun6ng Office Processtrtg Cotnpiet� Hate i