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<br /> rJ1,tMIU 1`I N'E ."moi €- FORM W0,Wc rymAm w wn, .nn
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<br /> 1ANK MRW71DR,
<br /> S. Us <a hai t r .,m wARg hamnaw a am rwAing 3 vT ,
<br /> TOP 01' FORM- 'MARX UnU,Y ONI'F, ITFAl'
<br /> Barn an (X) i,. 9w box _ent to i.e hem ,itat bem d 5ar11:nt IN n imin Me E ., n 4 MY r , , ,MI_
<br /> I. Ia Crtil ; INI€,OWNI'ION AQ, ADDRum (Mus-, Si? cupirl'u ti)
<br /> L Record name and address (p3 kal locsAsn) of IN ua dorprund t<an sy
<br /> `o f 1'. .Addk ss M IT i h c a .AdvAd 3,P:xz,. kwon ita, :n,'Inding cay, ,S , s a,a fir t.."W"
<br /> P.0, BOX NUMBFULS ARB NUF AC'C 1, I 1311a
<br /> Include neamst crams strcett and raaame of the
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<br /> a€ ,,.,
<br /> �Sr�
<br /> 2. �1ah<tnc taaaaaf.,r a�cast i,zan� an area fie. If �hv ia�flat numbernumber . Mef
<br /> :sa�tae.. u��r,§:F, N,ii ra ,.lap.r1c,-i€�i°.i_,
<br /> 1 Check We a;a>ecal?siate boy Or 1PE CW I31,t*,;° AS 0W\FRS1I11' (ct, kDRIPCHAAMN. KItf.lF:f.".AL. ow i
<br /> I, C tauk the apmThate box Or 'l 1RI' Cki' III. ,ani S,
<br /> 5, If t aehay/SitC ,s ier a ed its` Kin an Tsarr a re c.-v.nkm or Indwr a.nthan ',um Kn fy CK,-, Ow h3w in Pic
<br /> `'. Cmord dw ERA, 111 # or x,aae `NO:N ',' is It""c' spscc prover <$,
<br /> 11, PROFI':10 ' f2WNER IP`II IYI. r rION & ADDRUNS smimr Bit I"C;t 1 'I.I{"'3,f:f'f
<br /> £,onwicb; aH warns In his scegon, antes; au ham an Me ow 1r SIXI AN 1. f he . paras rvrf�- '�,`MIc, A b
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<br /> AN section- Ifs, swe. to cKck W.)P?'>RT 0Wo,'lcRS1Ill' I1' I1 box.
<br /> 111, TANK OWNER IMU12 WON &AMDW&S (Mus-1, Ill:c`C3P peril ly
<br /> Complete all itesa2s in this noon, assriess all iterats are be same as Sl3C"1"WN It If the same, wric° 'ANO NS TWIT. �...v.,.,
<br /> this smion, Bc stcs'e tai cheek 'I' N OWNI,'RWU PI?lim,
<br /> IV3C} l1IY C)1= C ,' I,I �'1`tiY t:. s1" t1l,: C.ri, a Ii1i zSt"C`<:IL, vl' IT3I11.�RtI)�1° ISI: "CY�I.1?1I��
<br /> Raw your-Boar,d (1I0I1) US'L stc-nan,' fee aC-couta n f h r which e, required bol`ore yCur irarini
<br /> can be l,mo ..,d, Reosz.wkin a th tine HOE wM c,.xum Hum pm wM rencive .a `cc, a,Fans= in =oar it wi
<br /> &JWW in We) pr pHou Re e1w on Benmbcr of p1lores ,a mem In y<a rr LAIL the�B U ,x (wryss 2 o ._. p- .
<br /> akin➢ tire stornge fee, so mclums MH not he tea,. If yen ua£ no! have an account atas,,hor vfll :" or- . ,. - .
<br /> quesfio325 F"(,:gailli€, the be or Eer.f rliplIcua's, pleaw call be 9116-323-9,556 or w-he to IN 1h,"F at „:_
<br /> Bowt of I,.lwa}azedioti, En .ronin .arid 11m Unk PP. Ma 9= Sxari,anie a o, CA 94, i l)G 1,
<br /> V, PI'""I'I2CIi,EIU UEJ!'FINANCIAL IZUSPON IBU.11-Y ( TSI'BE(X)NI PURI I7
<br /> ldct tify the me=tiody)z used by the owner, mid/c>r° €>tiera+sic ins ratcc ng tire. Federal and State fa.ane tl C!poti,,`=iiiay
<br /> requirements, L,`4"I:s r>;=.ned by any Wen!en! or Mac .Agency are exempt from. this
<br /> s'c,t ,K°a,,aieaat.
<br /> V1s LEGM, NG.111710VIION AND , C'x CLF' S
<br /> Check ONE E BO for tt2c: a drt ss Maar nail he usecd Ior I3 TLIl IJlGA1,AND MUM(; d f I FU YV1It N ,
<br /> 1XPP11CAWMIJ51'SIGN AND 1 X1711,11111 I` RM SII Ifxa;1IC207EY).
<br /> 1N1,;FRUC1'10N FOR LOCAL AG11SlC',11iy-',
<br /> ']'he tasu`tty and it risdiC'tPon numbers are l,tedetcrIshnett and can be d}f?.;<vh ped by calliTlr'.', the y[<w Board (916)7`39-242j, 111:..:. ...
<br /> facility ,nsrailar t r nay no Wgrre l by alae local aai;ency: laowe cr, this nnniher nius, bm nurnernall and ca ta,s, a.=rest. n <atw
<br /> al€afaam€ts,al. If ifte local agency f>ze;f` m tine Matte Bowl to assiyn the aardity tomb r, f,leaaa 1"r < - NA,
<br /> I'1'K;'1 W, °�SWO IBIIX C1I'11111 1,t'1UAL GINCY t"INT' INSPEC"IN"fl it.F',11,'1IF EY '.I-Cy vial-A 1 Y ;,UE,
<br /> ACCURAM OP ITUT 11sf1UR "'IOAN. '1111S A I'IC°MUCIN CAz°'II CIT BE PROC.UNSE l 117171U, IBM, 1sCXWl Wc
<br /> NUMBER IS (YI' FILIJUD IN. MUT TAX141,AGENCY IS 11.ESPON1111,,F, MR1111i C:CITsYf'1,1;1'I«ti (W731E,
<br /> '11WAL AQ?NCY WE CININ hall FROM O MIX D MR,FORWARDING ING ONE 1="C'a11M 'A" AND
<br /> RI)C IN I t) 1URM, "I?(„)TO 1".11F, te«UAWING ADDRESS,
<br /> OR CATIF'ORNIA
<br /> IA141t WjV111R RENO IICCE CSC 1 01,YYCCYA11Y1
<br /> PD, BOX 527
<br /> PARAMOUNF, CA s 3'; 1
<br />
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