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San Joaq inu County,Environmental Health DepaRm nt
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<br /> MASTER FILE RECORD INFO "'MFR" GREENFORM
<br /> . INFORMATION i
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<br /> OWNER FILE.. ...
<br /> Compurr myEfnteow maPROPE29Y OWNER fnrFoalllulrroN., CSA v OWNER CunrP[arrt►awseE tevrrr EHD
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<br /> BW W FJO NAME
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<br /> Owner Nome Address �J
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<br /> FACILITY FILE' -
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<br /> 0b'AIrPLErETmEpmtowlNc BUSINESS I FACILITY]SITE/NFofimrtom
<br /> Is this a New BLmiams LOCATIoN not previously rimplatod by the ENVIRONMENTAL HEAL 7 I DEPT.7 YEE ❑ No !
<br /> Is this an EIASTING Puffiness LOCATION but n NRw TVPE of rogulated Businoss7 Yfill b, No ❑
<br /> BU81etElt.NFACI[MBRMNAME A-Ac A• T,,vt.�C Wq
<br /> SrreAootares 10Z 7- Fto,vTAGE Ko�q Sums Bust"esnPNON� lZ�9 432'S 6 '
<br /> Orty J STAT* (A Lr ll
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<br /> Melpnp Address City C.,, �d STAT" CA 21rr 14o-7 o I,
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<br /> TMRO PARR BILLING INFO& Com#otle If Billing Party Is diflfprontfrom pmporty Owner orFaclllty OpOrator/d#m edab0v4F
<br /> 6rtanlsasNarS Altenllon:ar'Cate0!/epeferrar)
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<br /> Ms&Inp Addrosa PHONE
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<br /> Cm STAT@ 7Ar
<br /> Ae�nenVrdppgi>ly for fees and efiar11169 OWNER FAcluTYIBUSINESS TNIRD PARTY BILLING
<br /> Beit mceNn CoarntANes Actmoxr t nemeNi: I,the undenipod Applleml.oordlT Thal i+M IW Olraa•,OpArtrmr,nr AAUrnritrrl ANr rrr of ehh Barfneu,oaA i at wo-Atdge that tett rEe1f17r .nen.
<br /> ft"m EmciftomwC"'Stand/or NO=rCltuGttsnaoelntedwith obbopernsRavaAeMlledtoraeatWenAdrophisour*dabove AsIboAccoMmnim tt'far Al+Pitt.fage ew01ythat
<br /> All II&nnM4os proTldeA an thle Applteallort Is tree avid correct;And that nil rgpdated aerivlrlea wtil he perlhrmal to oee*rdonrt With all rpp&cable SAN.TnAQWN COUM Ordinance CndeA medlar
<br /> Slaadards and$tATLandfor FOIBSAt.i.�wr and Relttl4tMtnx At the Uedercl&Aed eWntr:Aperafor,ar o&ett Of the rmpsm loaroA attbe vie&Ily/tlb eddrea.,l fferetry aslffar!>re tMe rekna el'
<br /> ally cad aU rectus Wad tewlrotprlAaral aeursmsat Ihrormarloe tp SAN JOAQI'1M cox"Ty RNVIRONWNTAL t18ALTH DE! M aetm as It a nvepah4 and at the acme Oats N In
<br /> provided to 06 for ray,repraalathV. eE PMN
<br /> APPL,ICANTNAME Ly rVr AN ?Y ,t3f� el?
<br /> - _ -ATL[ F� BIONATURE
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