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;� c '�d.:'J'. �Z X ! m <br /> nft�'Pc�l'�3 jil/i�L•3Ft .... ._...._ __ <br /> OATS ll Z6 OU MASTER FILE RECORD INFORMATION FORM (EHmlwner�eP.e:,vs;7 <br /> °_� � hy.:.�'<°'£'k.. vz, i.. ay^•f"+ '�S" V. SS i^ e>i .�k... <br /> UNIT IV <br /> 6W 006Y,P 7P OWNER FILE <br /> COMFL,ETE THE FOLLOWING BUSINESS OWNER INFORMATION: CHECKIF OWNER CURReNr<yo.ralcew,r,,EHO <br /> ................................_......_.......I.............................._._.-............._.._.................._............... .._........._.................._.._......__................... <br /> BUSINESS i PHONE <br /> OWNER NwME ._---------------_____------_ _---__--; <br /> —�—_�— <br /> ..................................._...._........................FjrA.......................................•!!........_.....................................4?3r..............._._................. ` <br /> BUSINESS NAME(If diAbrYntffom Ovvner Name) ! SOOSEWTAXIOA <br /> WILD ROSE VINEYARDS <br /> OWNER HOME ADDRESS 1294 COLETTE STREET t ORIVER•s UCENSEA <br /> chy <br /> LODI STATE CA LP 95242 <br /> OWNER MAILING ACORES3 (ifOIFFERENThvm OwnerAddr ) ! Attention:or Care of (opbarrdq <br /> MR. ROBERT LAWSON <br /> Mailing Address City State Zip <br /> H- <br /> ==a, <br /> INDIVIDUAL❑ PARTNERSHIP LOCALAGENCY0 COUNiT AGENCY❑ $TATE AGENcT0 FEOAGENCTO OTHER❑ <br /> /ab FACILITY FILE <br /> •�t1'✓in <br /> -READ" .k::. <br /> .�D3s•Rt�f .. .'.aeaaaa',�+rt ut4�t n.�efc�S'!°:iY�vi.'�� .l iJ� f+� rta.:a <br /> COMPLETE THE FOLLOWING BUSINESS I FACILITY/SITE INFORMAT/ON: <br /> Is this a NEW Business LOCATION not previously regulatod by the ENVIRONMENTAL HEALTH OIVISION T YES Cl NO M <br /> Is this an EXISTING eusineras LOCATION but a NEW TYPE of regulabad Business 7 YES M NO ❑ <br /> BUSINESSIFAGIUTTISITE NAME <br /> WILD ROSE VINEYARDS <br /> SITE ADDRESS i SUITE it i BUSINESS PHONE <br /> 8751 EAST HIGHWAY 12 <br /> cl Y <br /> STATE i LP <br /> VICTOR CA r 95253 <br /> r�ks a�rTnC'3ssiacavi%sns34EZ. 3c i`cr"tk`,.s� i'N-a✓ n�»rnr.r`` `...Ri?"e�i` IeeomS . 'yir�.�-nY:ti�.�: ,`,3y,-A'stm„'.".�t5,seed �.Se ,,+�fii- l4 '�e£;1`'.li.".P.�:;.Siz'�v`'. <br /> - I <br /> Mailing Address ifOIFFERENTfrem Facdity Address i Attention:or Care Of(opUbmul) <br /> MR. ROBERT LAWSON <br /> Mailing Address City STATE LP <br /> S ` ' I'^r 1 ^2^eva..:.-,�e: .'r I _•� w '¢r..+v..h , e-,F,v .iy �..-� <br /> IS[Fn:•dCao&'.V'Se„4:c��.Y.L`•P�..kS'E�"�S. .f3"_ Www'.-'�.E.x`�.' �a""•eb�..i�.,W`�'....,� A'CL��.HiExE '•tst�.�'�'.dat�.�.� ,5a. ?i--w`r€tly:�.. ':•.1Jsrr-a''''�� yt•,.�"^` '„Tv' <br /> THIRD PARTY BILLING� RIF <br /> � h <br /> INFORMATION: Complete Billing Party )sdiffeTentf omBusiness Owner /dents{edabove. <br /> BUSINESS NAME Attention:wCare,Of (o tionogg <br /> GEOMATRIX CONSULTANTS, INC. MR. PAUL DEPUTSCH <br /> Mailing Address 2444 MAIN STREET, SUITE 215 PHDNE 559-264-2535 <br /> olrT FRESNO STATE CA i zip 93721 <br /> &,Cmu&rApDRFSq for fees and charges OWNER FAOIUTYIBUSINES$ THIRD PARTY BILLING <br /> BILI.IN'e AND CDMP(.IANG£4CKNOwCPUOntP�rr 1,the undersipgne,i AppllcSnL certify that I am the Owner,Op wor,or ejWAvri;ed A9genr o u IuIh.SI and I aclaowledoe that all <br /> PeR ar F££S. P£NHLR£S. BNF•Om=Ax;,T CRA80£s andtor VovRDr ozAac==oda[cd with this uperation will be billed tome at the address identified above as the rror <br /> ADDR£s�c for this site. I also c-airy that all information provided on this applieatlon is true and corrmt; and that all rcoulatcd activities still be performed in accordance with all <br /> applicable SANJOAQULN COUNTY Ordinance Codes and/or Standards and STATE and/or FEMCR Laws and Regulations. As the undersignod owner,opemior.or Pent or the properly <br /> located it the above raclliry/site address I hcmbv aorhoriae the release or any and all results and enrironmentd asam000 t information to SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION as soon as it is avoilablc and ad the acme time h is provided tome or ' Pr c niadv .. <br /> PLEASE PRINT <br /> APPLICANT NAME �jj�,u` L.. SIG <br /> TITLE DRIVER'S £N$E A <br /> P�L�~ �' C� (PHOTnrDPV RCO11 RFn1 <br /> ra„`c6 F' r`�:�s l: ra %.'�'•;x,Y4 7°`u tYa �� ��♦ s .a. >w <br /> SPP.: gy �s.,-.sp �FXife�. _ <•�..u;`., ..A'ccULs>tirf6'Offlwacos`tariYiG__��LL�� r�38`. �-o� .. 8kr ��' s i v--,v;.t <br />