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03/30/2006 20:27 12098643 • PAGE 02/03 <br /> San Joaquin County Environmental Health Department <br /> DATE <br /> ( �� MASTERI FILE RECORD INFORMATION "MFR" GREEN FORM <br /> I <br /> `� WWWJJJ � ILI <br /> UNIT IV <br /> 2W, 0 1.x)D O kqq I'l �I OMER FILE <br /> 7711E Loh7/P6 P f, 7-MV., LARM0 OWNER Cbxneerrzrwx mire END <br /> PaaxamrDwNer NAtte I.Tk�Q- P" aoa-869 --71;8' <br /> rr Lest 12Z <br /> Busu�.4 Nage ' C l v <br /> C, M4 <br /> ���{e c O1an`�i���� 9xs�Jnu�m, <br /> Owner Nam'Addeg / /ti 1 I Flt rte{ c: +T-ceii Varm3L7 MR*CRY <br /> - <br /> �JVNeC1`fryJO`lye S`V C p 7y° <br /> Dw MalllnD Addrpp 7,( <br /> MaIIro9Mdre cay �•t�,��Cba.m.K star. C,R zV CLS: %� 7 <br /> CDAPORATaMe❑ RIRI�RAL{-I. PxMnq 17 FenAdeicr❑ Dtraae <br /> FACILITY PILE <br /> iPl` !�Irxhk it 'IMrIt <br /> I5 this a NEW Brislnees LDCATIDn not previously regulated by the ENVIROnwv�TAL MrALTN DEPARTMENT! re O No ❑ <br /> Is this an EraPM Business LarAT1M� N but a NEW TTYK of regulated Business? 4 Yee ❑ No El <br /> BUM"Rs/FA=MfSMNA C1�T 0^i' htg2Cly.nn W�0.ysTr1{C wage c~-(cC me,� P�r\t <br /> SMAaeRLO 'l3 (r.�sL SatA,J11. �G.n 'lt Fe.. r' 1.J�`V BDSIIY65n _2-)^170 <br /> LYr�' �AV[.� 't)CON F.. ,TA-CA z� <br /> ecwm�oskvekevCrth yrrmrc� pLocx saai*X iml � is ii - i n <br /> F Ifri 11 <br /> �, ii ill <br /> Melllnp Addrt4ti;r DTFFFl7tryTJrrXn Fi.NAPy Aft ADernbm.� cis Of(ppnonaq T. <br /> M,Mnq Add,e ❑?y <br /> STAtL ZIO <br /> THIRD PARTY DIMINO INFO! @mpjfe�p if F ANITg Party Is diPT-n ff from Property Owner orFacilitV Operator Iderrtlfied aA�ue - <br /> eDSUMBllArrr AIIBIelort:Afars Or(mdh q <br /> Pnbee <br /> Crrx ZIF <br /> AcANATA4WM for fees and drarges MMER FACILI Y)BUSINESS TIRRn PARTY BIW NG <br /> anr.w.ran lyilRrlbvry xrl�oa+r�w�._ 7.IEe®dernignd APLArron.mtiff0-tI me,c lMma.OAaarm.m AWhodxdApenf vfdA Hueh�ad l ac1a kdee that an.PAxftrFEK <br /> pMrAIIR",r�5TareRtArnNr OUAntSandferlrowA.rgrnAeef eaeerLrN"uh iMe opcmdoew®be bnkd mnK xt dre xddrt Nend5erl ftn m rbrd�dfar ddt d Iow arra}dw <br /> on IAfo...ndm provided eA d6 AplAtemixn 6 R'ae gad!6.108 xed drAr AQ mpbt ed ae&utm will be perknued is aeeeNaveewkb xn APPikabk SV+IUAQ Dr Mo Coda mdkr <br /> SnmdmN ana 9txtA xoNor Pr.ItAeAL I.Awe anditeIInktlmu.bdn mMerdroM oweer.apereter.marmenFlbo property loeapy gj�r'9�re Phmfdnrghlk nd I h My aummare ati Nueaaf <br /> ory and en nealn mid tnvimmrwaW arammen bMornrtlm b SAN 30AQUIN COtJ,NTY Tt'7VypipN.rytBryTAL REALTR AFRAR7ri1$N'p eaAe m i 4 k d xr the tarns dme It It <br /> p.wided romeormy.gmeeenexrFe. +/+ // <br /> APPLICAM NAME PIAA��Ir <br /> 516NATUR . <br /> TF17.Z C DRIVERS LICOM d <br /> fl �r fneDrDmtw'tara'D7 , <br /> appowp ey wea AMknA q eek.PAeerhm rymdxhrd ey - - -Ate <br /> 29.02.002 W 25,2D03 <br /> CONFIDENTIAL <br />