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San Joaquin County Environmental Health Department <br /> DATE 04 Sep 2007 n GREEN FORM <br /> MASTER FILE RECORD INFORMATION MFR <br /> a.n .�.,. pamrAlDa' cAEa UNIT IV <br /> -OWNER FILE <br /> CONRLMWEPOUOH7NGOPER WN NFU A770N: CWOfff OWNER CVnaE 1v OXLF n RHO � <br /> PaoPurr OtrnOt Na+rt Port of Stockton pNDNE (209)946-0246 <br /> Fkif Mi Last <br /> Bwmm Note Portof Stockton snestcl TATIDa 94-6001403 <br /> Owner Hpme AddmD, 2201 W.Washington Street Panrn's 1. At <br /> CRY Stockton STArr CA zm 95203 <br /> Ot MaVltp Aden P.O.Box 2069 <br /> Mafling Addams City Stockton state CA zip 95201 <br /> CcwaaA 13 Dltmmuu❑ pAATHeasm� rko/lewcv❑ Qttmaix <br /> �16b\85 b FACILITY FILE <br /> t 7 qq[j r� +s i-0 k f a e ut�yeya , <br /> FAOIm,ID..a Cliosb RerID-C.; SLA µ �.IDitk' 2 ' 'E LJ'4i15 , yy�li <br /> Is this a Nov Business LOCATWN not Oreviwsly regulated W the ENVBTUNMENTAL HEALTH DEPARTMENT? Yes ❑ No Ex <br /> Is this an EnSTMG Business LOCATION but a NEW TYPE of fe9ulaited Business? Yea ❑ No I x <br /> Bb MSIFntnm/Sm NAW Buf ding 312 and Parcel 27 <br /> sm Apwess Reid Drive at Luce Avenue,Pori of Stockton soma tivsmets PttO.E <br /> CITY Stockton srATe CA ISv 95203 <br /> MaQ1tg.Addm%4'D.rfFERFNrf MFRCMyAddress Attention:or Cate Or raPA6mmn <br /> P.O.Box 2089 Rita Koehnen <br /> Maaing Address Cny Stockton smu CA 7]E 95201 <br /> .ip Y ',yda7Sti�:#tk,vx� ' :r ry.-;x,hfy u.Uyi +.� Tr rmyli ^f�Kl J tx ti:> tyM;. <br /> SIC <br /> OJnE". ApN a._ ` '4 J 4y^: 5,ix' AS e i'�L fn+r .L. <br /> .Mt' '� a1!11Y ,n i ?. ,i4'! ',r "4'i'.rk ,+n1y��,A'4i,�.,,'r .'/E . <br /> THIRD PARTY BILLING INFO:-Compkfe if Siping Party is difTenent ftm Property Owner orFanTRy OperahTr fdwffied above <br /> BtS KA.E Attetdlow wCam Of ropCaml) <br /> Malling Address PHPae <br /> Cm $TATE ZIP <br /> A 'for fees and tdvatges OWNER FACILITY/BUSINESS THRD PARTY BmuNG <br /> n vn rnwn,.err ArAvnu�rnr.+mrr; LMe nntlenilyca Apdaisaat«nifY rM tem tl,e Oxm,Upoarnr,mAethnriWA,twaltlro Hnlvtn,aad ladmaw'fedF ihptpVPouurfNcs, <br /> Pt1tA4nA�ENFOAGCNFAT(T(dMiAandbr/IQfiaLl'GM�ET'alaodated with tldt aperatimrrID O<Aplea Was alNroddtea WenrifudaLvvens tlyArrnrmrannanr(�me allF lalfoaaYi$dtat <br /> N mfvn®five prertdrd oo Uu+appGtatiex 6 trot Bad mtraN wd r6et a6 regu6tM Damien will0e Fetivrnrdm umtdavv w5eh ao appHaWt SAH 7MpVm COtmT Ordiamn Coda agd�ar <br /> Standards aad$TATL atMlvr FTn�Av[awdand Ragulaaaw.Ae lhv uedasmed awns,grcratm,or egmro(fAr progeny laatal at me obmxfarHNy/dR(ddna,76en6y aathvritc Ns rdraxN <br /> I vq'and ill ranlb Md fto'm j asttvmmt ivluramtloA kSAN.IOAQNN COVWV DVVDtONAflUTAL HEALTH DEPARTAHNF as aom w H IS m,SbI& W e1 Me ume lime it e <br /> i pry idw mvv.v tar rsrya Wla <br /> 1 <br /> i APPLICANT NAME Jeffrey Wingfield PtcASE PaTNr SIGNATURE j, /.✓..7 _ <br /> TITLE Environmental Manager DRIVER's.LteErLSEa <br /> tElfnitKDYY uouttmnl <br /> APplewd BY Dab Aowntltp rdlva Pmmsiw CmnpkHfd Ily - nate <br /> 29ALae2 April 2I.2U43 <br /> CONFIDENTIAL <br /> • • <br />