Laserfiche WebLink
San Joaquinq Count Environmental Health de artment 4 <br /> Y p <br /> DATE aMASTER FILE RECORD INFORMATIt'N"MFR" GREEN FORM <br /> SrrE MITIOATION&LOP <br /> BRAND ANUS M 1HD,U,§E0sar OwNeR�roll CASE UNIT 1V <br /> OWNER FILE:Coin+LEwTwroccomw PROPERTY OWNER INFommTfDN: 011MV F OWNERCIAMMUONFILEMM EHO <br /> pROptmrrDWNEltfd�We" '�'Pau1 Lambert I (63P 963-4094 <br /> F7,0 M1 PRnNENUMBER <br /> BIMINUaNAME R.F. Land t E-MNLADpRlsa <br /> i <br />` Ownttt HDmaAddrees 405 West Pine Street <br /> CIO Lodi BTATTt CA ap 95240 <br /> OtmerlNAilingAdheas same <br /> NIellingAddreasCity Same elate zip <br />�. CORPORATION IN INDNII11)AL0 PARTNERemp❑ B :Feo AGEum 0 OTHER❑ <br /> I <br /> m Mm"TiDN_raimnONmmrAL Aa4eswINEPfr_VOLUNTARY CLIC wup,_WATzR QU kAu",^iHW PIPELINE 1w.n"GAT10N—LOP XX <br /> It11 <br /> l <br /> FAOILITYID* IgVe AwOUNTID Ppivoo11 <br /> W., _1 <br /> fflo <br /> r <br /> FAC1Ln FILE COMPUffTF wErOLLOW1NG BUSINESS I FACI UTY 1 SITE INFoRMAwN::I <br /> l Is this a New Business LOOATION not previously regulated by the ENVIRoNmENrAL HFALIN DEPARTMENT? Yka [INo <br /> Is this an EXISTING Business LOCATION but a NEWTYPE of regulated Business? Yea ❑ No$J <br /> O WNLaa1FACILITYIerrENANIE FORMER RIPON FARM SERVICE (RF LAND).k <br /> SimAoGREeS 8Ut1EAI BUaINEae PNGNE <br /> 932 EAST FRONTAGE ROAD <br /> D"' RIPON STATE zlv <br /> ;�, CA 95366 <br /> 80ARDOP8U&EIlIR9(ebFehKT Lo°ATit»(oona KEY4 KttYt <br /> 111M11ng Address lrDlFF;ERfiWfiIn"Feallh'yAddroes Attentloht oel)m Of topHonal) <br /> MallingAddreseCIly STATE ZIP <br /> BlCbaoa 7APN 9 CoWnir <br /> Tti1H10 PARTY MiL.L ime INFO: Complete if Billing Party is different from P .4y Owner orFaclllty Operator fdenufled above. <br /> 8lN83NESENAk9 RF LAND C/O PAUL LAMBERT ,Attentlon.orCmmOf,(ophlonal) <br /> McRingAddreee405 WEST' PINE STREET P"°ItE 6309634090 <br /> C"y LODI STATE CA Trp 95240 <br /> AI <br /> i. for.fees and oharges OWNER FACiuTYlBusINESS ; THIRD PARTY BIWNG <br /> 1,the andenlIp"A.pocanf,certify that I aro the Owner,Opoww,er AushorfcaAaeer of this Bull ness,and I sale .z,that."Pe turrloeat, <br /> Pmwcna,EiYroJrostrErvr ptsitots aud/er NovNSY4Hr rcu auodated with Ibis operadon"fil be billed M me at the address Idendliod-"as(beAm Ier thh sltm t aLe eertlry Ihss dl <br /> Informstlon provided on thls apPlladoo h hue And totreoh and that aB regulmcd atdvldto"Ill be performed In AefordA�with-11'AppHuMe SAN IOAQUIN Cou v Ordinance Codes andlor <br /> s4Adarda and SYATY and/or YrDLRAL Lawn and Cteeulallom. As the ander0ped owner,operator,or s=ent of The property located At the above heltltybtte address,l heraby mwbwlx the Meats of <br /> any and all results And textronmental usestment Glfonitadon to SAN JOAQMN COMW ENVIROWE1a'1'AL HEALTH DEPARWRW As Loon u it Is available And at the nme time It Is <br /> provided to me or my repreaentadre. - <br /> APPI.IOANTNAME(PLMEPaw) Paul Lambert SIGNATURE` <br /> Tint? TAX ID# <br /> rI I <br /> DsLe <br /> Aoccunting ORioe Promaalnp Completed By �i Data <br /> 8I11EIIA MAT" AsaouterPAID DAtEwPAnasNr PAYvamTTfPE REGEIPr! 'OHealeA RectrFEDBY S; Lp' {' <br />