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San Joaquin County Environmental Health bepartment R"llifED <br /> DATE 7 0S MASTER FILE RECORD INFORMATION "MFR" .I E+�f� T7� y��Ln[ <br /> OWNER ID# CASE# tfI4I0r 4 r05 <br /> N <br /> OWNER FILE JOAQUIN COU <br /> p/t'GCIF owI�V�IrF&NiA¢E1yp�tL <br /> COMPLETE 77fEF0LL0WING PROPERTY OWNER INFORMA770N: <br /> PRoporrYOMERNAME PHONE 209-599-9000 <br /> First Ml Last <br /> Soc SEc/TAx ID At <br /> BUSINM NAME The Wine Group, Inc. <br /> Owner Home Address 17000 East Highway 120 DRIVER'S LICENSE# <br /> Ciy Ripon STATE CA 21p 95366 <br /> Owner Mailing Address P.O. Box 90 <br /> Mailing Address City Tracy state CA ZIP 95378-0090 <br /> TVm OF tw H <br /> CORPORATION'A$ INDMDUAL❑ PARTNERSHIP El FEOAm 11 Orion <br /> FACILITY FILE <br /> FAmuTYID# �OQ�7h/_� CRosS REFID# ACCOUNTID# /J/�J/D / INV# '_r .I <br /> MPLE7E THEFOLLO NG FO TION' i / n� <br /> Is this a NEW Business LOCATION not previously regulated by the ENVIRONMENTAL HEALTH DEPARTMENT? Yes 11NoNO <br /> Is this an EXISTING Business LOCATION but a NEW TYPE of regulated Business? YES ❑ NO ❑ Unk. <br /> BUSINEss/FAaury/SrrENAME Franzia Winery <br /> SMADDR68 17000 East Highway 120 sum# BY{}�sSSP�r�rE0442 <br /> CITY Ripon STATECA zP 95366 <br /> BOARD OF SUPERVISOR DISTRICT LOCATION CODE KEY/ KEY2 <br /> Mailing Address iVDIFFERENT From Fac7lityAddtess Attention:or CarOf(optional <br /> Same Dwight Davis Plant ng. Man. ) <br /> Mailing Address City STATE ZIP <br /> SIC CODE 11 APN# COMMENT: <br /> THIRD PARTY BILLING INFO; Completed Billing Party is different from Property Owner or Facility Operator identified above. <br /> BUSINESS NAME Attention:or Care Of (aptloeaQ <br /> Kennedy/Jenks Consultants Mike McLeod <br /> Mailing Address 622 Folsom Street PHONE 415-243-2508 <br /> env San Francisco STATE CA ZIP94107 <br /> m for fees and charges OWNER FACILITY/BUSINESS THIRD PARTY BILLING <br /> M ^COMPreNry ArKNOI'.^.FT MFM: I,the undersigned Appli..L rectify that I nm the Owner,Op,rR ,,or Authorized Agent of this ITusinesa,and I aclDmwledge that all PERI➢TFM, <br /> P,,vJE ,FNFDRcestem'CxnRCEs and/or HouRCTCRnRCFs associated with this operation will be billed tome at the address identified above es the An, Leff ADORFS.e for this site. I also certify that <br /> all information provided on this application is time and cisme t;and that all regulated activities will be performed in accordance with all applicable FAN JOAQmN COD Ordinance Codes andlor <br /> Standards and STATE and/or FBDfBAL laws and Regulation, As the undersigned owner,operator,or agent of the property located at the above facility/site address,I hereby authorize the release of <br /> any and all results and emdromnental assessment information to SAN JOAQUIN COUNTY ECNIRONMFNTAL RKALTH DFP asIt Is available and at the same time it is <br /> Provided to we or my representative. <br /> pPPLIGM NAME <br /> MIke McLeod PIEASE PRINT SIGNATURE/ <br /> TITS <br /> Geologist DRIVER'S LICENSE# <br /> g (PHOTOCOPY R OUIRED) <br /> Approved By Date Accounting Office Processing Completed By Lb I Date IAq 1, S <br /> 29-02-002 April 25.2003 <br />