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roar IENDofslat•MEPban�tsal <br /> DATE IO sill MASTER FILE RECORD INFORMATION <br /> U N lT IV <br /> 3 3 �5 OMMER FILE <br /> COMPUTE THE FOLLOWING BUSINESS OWNER /NFORMAT7oN. CNecom, OWNER CvRR6 rtr ONFicEwrru ENO <br /> .�.._.�. ._._....—_r_.........._.._-_.—AAAA.._._... <br /> -- <br /> Busttdsa 4 Cwcx NAME <br /> � <br /> 0"E1 <br /> J93?5 —55325gBsAV2 <br /> i <br /> 0U71NETS NAaE M dlgOrMt/1Oew OvYnwr Nan») � SOO Sec!TM t0 d - - - - - <br /> I Owpw-R NOME ADORIss 6':J FOVILT-4 -5TQ VT- fib ST i OPlvprs LICENSE tt <br /> SoreloM,A CA 1 Z 9547b <br /> OMNER MMUNO ADOREss (TCfFFERENTISpP 0—,—AdCrttw) Attention:orCarw of (oppiprgQ <br /> E'R Ng N S EN <br /> AA .Ting A Dross City Sbtn { Zip <br /> COAPDRAno N,At iNomOulu,❑ PARTNERSHIP LOULACFNcfc COUNTY Aa E3 STATE AGENe fn FeDACENCY❑ OTHERG <br /> C C FACILITY FILE r a <br /> K Mian. �� V.r..ILY 4i-- Y 1) :1'.N .L—i4 YIYMaM �ilYY1\�. <br /> .W44y-1P�.C`3_ITy' ..r<9n.L;...i.Yy;!llSs�fCi f:G. a 'W—;_. �' — <br /> ComFLETETHEFOLLOWAVG BUSINESS / FACILITY I SITE INFORMAnav, <br /> I0"a NEER etsain¢ss LocanoN not vnuvioualy raguLstndtyQ,*ENMRaMMEARAI HEAt.TN OlvtltoN? YESG Nom <br /> IC Oto ,EsIsT1.6 B,,WMaa LOO•nON but a NEMTYPE ofrsgulated&esiro sa'p YES jt No Q <br /> I <br /> Bu.TIwF311GAO1UrTISITE NAPE Tv2NER ROAD VINTNERS I 'E!A-5 - <br /> sITEIbDREaaW PHOME <br /> E 51" TuA N ER ROAD stmrEat 209)339 13 ! I <br /> ; <br /> ATT Lo�I srx IIP y52¢2 <br /> ,;ea..._ ... '--v^ne il:�.1=� ZC�:.Tj'li .'° :. ...wP3i • ,�^:.' -.�-w> I <br /> Mwffing AOOras+XaIFFEREKT1rurFaalMydOdr® ? Attanoen;er Can Of(apuanao <br /> ( SAME h5 OwNeQ� FRIG fIAIISEN <br /> ung Addy Gty i STAT6 I ZIP <br /> ",'t.�...'...__..Z "!. <br /> THIRn PARTY BILLING INFORMATION: Complete if Billing Parly1is different from Business Owner/denied above. <br /> J••BtISINFSa NAME •—••••_•'•- -••�—_.--.. •' Atranton:trrCYO Of /OPr(ptaf/ <br /> C64AC As OWWIrrIL ERIC r/aNSEN <br /> hta,kng AddrQa PHONE <br /> Ctrs STATE ! IIP <br /> Aceoe 55 for fees and charges OWNER FAGLrrYBuswEss THuw PARTY Sit 1T1G <br /> Biltrr.,asp COM t©C£s.xrntwlr^�.�2`tT. 1.the 0.e,pyewm.e,or rldL..r:Fl.itmu al Ihb Bwiucs.and I acknowledge that all <br /> PFJUGr FX= ArAc"nis. ENyOPe ENSl OraAGCc and/or 110=r CfAAm'atmacaed with this operation will be holed to me at Or addrm IdandlIcd above w thc,4CC0fd2 <br /> ADDRESS fw this sine I alae evnifv that dl utfonsatios pro.'ided on thin application u tnc and co I; and U6U A mtuland anilides NI he perforsud in wcadance with Ali <br /> applicable S+n JOAQvly COL.M Ordinance Code andfor Sysdarda mad Sun a..d1w F[Dt La.s and RogulatimnA As Ha sad-nugmed awnm.apmacar,ot 26eot of the ptwpw.s. <br /> Io— a the abon facuih/site a"test_ I hereby aothatin the Mcaee of any osd A realm. and etHragttyglW Aafesement informati s to SAN JOAQUIN COtM'Y <br /> ENVIRO,`RENTAL HE_aLTH DMSIGN As nose as it is a\wilab4 and at the f ams time rt b pru,ided a nN v my np.eraev:.r_ <br /> I PLEASE PRINT - y� <br /> APPLICANT NAME E A I C. Ir . H A w 5 f P! SIGNATURE <br /> DRIVER'S LICENSE. <br /> TITLE COMPLIANGEPUTEeT' MANAGER pHnTnCnOY GCn.110 GR1 <br /> y:�Jdm.:r_`�_."" Ate. �.r-,..rAw s.. .�.�txo`t:e�0�0'rt�ratk'1a" 6�'. .._�=c^.a c�i�•r.._. l�' .:^:II <br />