Laserfiche WebLink
San Join County Environrnorital Health r -�%rtment <br /> GREEN FORM <br /> DAW MASTER FILE RECORD INFORMATION ilk MFR fir <br /> cwno,xnrwe cno FHf�,ICa�(x�� aiwwt ID#. _.. ',CASE#.. UNIT <br /> N I ■ ■V _ <br /> OWNER FILE <br /> f+ COMPLEMTHEAOLLt7MAGPROPE .OWNER INFORmATIVNJ Oy'EwiF OWNER 0.rza9wira'vmwwr7v EHD. <br /> PROPERTYOwna;Na- Port of ,Stocktonpliar.E (209) 94b-0246 <br /> ' Ffrst M! £est <br /> B Nance Port of Stockton SOCSEC/T-ID# 94-6001403 <br /> Omer HmmAddfrss 2.201 W. Washingtbn Street DRntai,6LicezE# <br /> Stockton <br /> _T <br /> City STATE 'CA Zm .95203 <br /> Owner Mailing Address P;0- Box 2,089 <br /> Mailing Address city Stockton State CA Zip 452 O 1 <br /> :CWPCPAflCN 11 p`DIi/m A_❑ Pam!W%_,T0 -�Ave l-Y.0 Orsi <br /> FACILITY FILE <br /> i <br /> Is thlt a NEW Business LOCATION not previously egUlebed by,the EPNvrRONMENTAL kEALTH DEPLi074ENT? 11Es © No <br /> Is.this an DcisTm.Busetess.L=TION but a.&WTYk.ofregulaiedlusutess? Yes ❑ No <br /> dLmuEssl0cnrn'lSrmkwE Former ,F,,alcon Energy/:ISC- 'Site <br /> . <br /> SrrE'pix�. #1 Port-, 'Road 21. surm# :DJON29.04O.NE NA l <br /> Cmr Stockton STAl •CA :zrv, 9520.3 I <br /> Bdnitp. ; ivls�k;Dlsimcr LDCATIQ�tCODE I Y2 <br /> 1(!Yl <br /> I <br /> Maifing.Jldd�ess r7�DD4�EA/TfraliiYFeaG[y ldd s Attention:or.CalreOf:(0.090011) <br /> Rita Koehneff <br /> Miifng,AddressCity Stockton STATE CA. :ZIP 9520'1 <br /> - <br /> ...... APH# <br /> TKum'PIMTV BILIUNG ItrFM Ctarrrpiete if Billing Pity d'iffert�ritfrcrn Property Owner orFacility ape�ator, dentifiedd�ve. <br /> -BLAS EMNAME NA Attentionar <br /> s CareOf (opftol) . <br /> Ma�tig Addis �� . <br /> i <br /> crry $TATEZp. <br /> AQ=UK A usocry far fees,and t:harges OWNER FAC[LITY!$USENESS' THIF3D PARTY&MING <br /> Rn'aarrr_>•itWCOMP11AN.rr 4rkwnzrxi5wyigr T_ L-the underdmind 1-wlnowteage ihat O'PEWIt'FFES <br /> Pr�vetYlES,GNFoxc rarGuracs,endlraITOURLYClI�IRG�aassod�edwithOldsopemdonwQlbAliWedtdme*thea4drenidmHfied;nboveasthe'AZ�(164ABESSforiliisdtc.Iginc. 6-ihat <br /> a iRfbrn--ion pravlded,en thls.skpplienU»n is trve>ind correct,.gnd.that*regalated'adlvisles-wM be perfitinied,in,accordance wtth aU'$0pHcqble SAN JOAQUtrr,COURT-Y.Ordinanee Coded and/or <br /> Stmtdm AA'mLd.STATE and/or FEDERAL Laws and Regalailent: Aa'tha indeaigaed o*miiil:ap'erator.'or,'agent ofthe propOV located sit the ab uve fadHo/cite-addrem,I hereby aythoim'the rdeare of <br /> any.and Rlresmts and eivlronriiental sisesiment,lnformadon to SAN,J0A{QUIN.00UN!Y E1VviR0NMEN'1'Ati FiEALTII,DF PARTNENT,es.Sobn as ft,is avaHablo'and at'the.seoe'tima it 1s' <br /> provided tom'.ear my ripme►taiice. � <br /> APPLICANT NAME Jeffrey Wing:f ield ��Pdv+rr SIGNATURE �;✓�� ���� <br /> TTTLE Environmental Manager like sUtENSE,# <br /> '(PHOTOCOPYRE0Un2®) <br /> Approved By Dalin Ama mno 6ftlo Pmocesaang Camle.ted By Date <br /> 29-02-002 Lr—f1 _ <br /> r April 25,2003 <br /> Act e� M' /d�0 -e Q mm <br /> 1. <br />