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San Joaquin County Environmental Health Department <br /> DATE 2i4 <br /> _ MASTER FILE RECORD INFORMATION"MFR" GREENFORM <br /> —.--_._—__. _ SITEOWNER IDR MITIGATION&LOP <br /> OWNERflLE:COMfK _.___ GAEER �o6�3 UNIT IV <br /> ETF T7tEPOLLOwVGP PRO ERTY0WNE ""'---' -- I <br /> PAOPEgry DWNER NAME 1 WNER INPORMAryO/y' CHECA/f OWNER <br /> elaer7(f t �I&t(' GTNRFNLYDNnEMWEHDEl <br /> m UaY) 9v7- I-77 -7 <br /> BUSINESS NAME C85f <br /> C X12 T„�(rn°}tdn a 7 PHONENUMeEn <br /> OwnerllortteAt . 4le S EMNLADOREsa <br /> city AN-Y� <br /> \� Owner Meptg Addraw <br /> STATE <br /> ZIP <br /> rs�aJ c�,✓ /`s3�O <br /> Halling Address City r <br /> state <br /> DORPOgAT1ON❑ C'/ LP 9r3av <br /> INOMDUu� PARRIERSx P� <br /> SITE MDRSATION [ FED'wENCYI� 1hxER❑ <br /> ._ NYIRONIIEENTAL ASSMSEENi—VOWNTAAY CLEIINUP_WATIR QUALITY <br /> FACILITY IDR INV# 1. HW PIPELINE INVESTI0AT10N__LOP <br /> AccouNr lD �. <br /> wv oo ����'` 4nn AeeIONEO EMPLOYEE LEAoADExcr:EHD_RWOCB_OTSC EPA <br /> FACILITY FILE COMP[r7FnteF`o�ttowmrcs8_YUSINESSIFACILITYISITEWFoenov:c <br /> Is this a NEW Business LOCATION not previously regulated by Lite ENVIRONMENTAL HEALTH DEPARTMENT? <br /> la <br /> IS this an FJIISTINo Business LOCATION but a NEW TYPE Of regulated Business? YES No <br /> BU9INESS/FAGILIry/$RENAME / YES E] NO <br /> T I r) <br /> SREAODR /-tavw. j E88 -- C ( J <br /> a <br /> I' 03 /�•�r ,n// -r/( SURER BUBIMEHIPXONE <br /> crc 1 — J61-1V7- 1777 <br /> I<"j-o Y1 STA,E ZIP <br /> BOARD OF SUPERVISOR DISTRICT A 7 LOCATIONCODE 9G Kw KD2 <br /> Malllrg Addross HD/Fr£RfNT/ron(�/FacilltyAddrscs / Attention:o CRre of(Oploml) <br /> Mailing Address City <br /> STATE ZIP <br /> SICCODE APNR --"— <br /> COMMENT: <br /> THIRD PARTY BILLING INFO: Complete f Billing Party is different from Property Owner OrFaCllity Operator identified above. <br /> BWINEas NAME Allantion:P Care Of(CpEona9 <br /> MSlling Atldross PHONE <br /> Crtx STATE ZIP <br /> AGGOU/dADDRESS for lees and Charges OWNE FACILITY/BUSINESS THIRD PARTY BILLING <br /> 0 �r,axp Cown LING,A s L C I,the undrnigncd Applicant,«tlify that 1 Am the OmnN,Operdw,dr An/fewt ed Agen/or,his Dusfae and i ncknosdrd,amt alt pilurn R'es, <br /> p$K.N]ILY,I:TTIHK£I?ATC/(IFGEe 9nd/nr 11011WVCrbUHib.va6aclaltnl with'116 UpenreOn Will hebillad tank.,dw.ddrtylOM11(ed nb.Yp99 -IpDREtf(ur it, IaLm nrlih thin <br /> all info rmatbn IvoridN on Ibis ePpGrnlien is hva and crrrccf:and that uil mylnhd adiriues rvill he perfmmPd in afcordrtneanith alta eshle Ser JCaRITv('omn'rtnhr ae Cndes andlur <br /> Smndards and STAreaM.br FTOTOnl.Lases and Re(ufadmW. Asthe undenigned mvneppperatur,oraKenf of llmproperty lns'nlnl nl the <f ciliryhit,aJdrrss,i hvefp'umtmr asbe relemeuf <br /> any and all results."d mirnnnsenlal astnsmenl infosnmtion to 5:\M1.IOAOI'LV(:nrNTv F.NVIIiONhIt:N'I'AL HIO\I Tt�DEPART11 'il s s uu as it(s a\ gaLlc and I e same liar,it k <br /> praaideU to lnconny lci a at:dse. <br /> APPLICANT NAME(PLERsE PAIW) L.f1A(LG["t OL-t--DA SIONATOne <br /> TITLE owrAfl , TAXIDit l <br /> A oved8 Oaln Accaudl OIRce Proceaalrp CamplaLd BY <br /> SIIEMIT10yyA'��TroX AMOUNT PAID DATE Or PAYMENT .PAYYENi TYPE RECEIFTY CXCCNR RECEIVED DY WORN PUIIPE <br /> FEET r W �. /h. ./'� f� 4 <br />