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Mab 16 03 02: 18p R 7 e=HWFI I N LAW 20' 956 4010 p. 4 <br /> 05/16/2003 1^:02 209468 AGE STOCKTON PAGE 12 <br /> / GREFN Fc)R.4 <br /> DnTg >} / MASTER FILE REDORP XNFORMA710N t°N FR" <br /> J <br /> 0WNFIR RIX <br /> C0WLr7 MEFCLL0WV0PROPERTY OWNER LWORNATI0N.' owrmjr OWNER Cv—Ewnvawmu I vnMehn <br /> PRopmry Ow"Im J Li FNOWt <br /> HAMM <br /> Bu=Nm Nun: 9oCS6C/TAx ID it <br /> ..o Lj <br /> Owner Name Address <br /> JAI <br /> C" S D C b N <br /> owner ftiandAddles, <br /> Malling A&tmv Orty S4lat 2iP <br /> re nF r]walt: -`— <br /> CMWUR TkQK[� 1laarrmuAL PAmiNtpotw G Tem Aayevr 0 I!'Jrrft!R t] <br /> rACILI'TY FILF <br /> ComPLFTl`TH,EFOLLOtt77W BUSINESS/ FACILIT'Y/SITE j/VfQ/�I{A1�M: <br /> IS Jhl$a New DWEIr esa LmmoW not ImAOUNY regulated by the EnYinoWr+arraL XMTn OUAR'YMFNr Yea Q nu <br /> is this an mare auatncss lorYtran esut a dtwTrvr of tegelatttd guain+as? YES CJ so <br /> 6tmotcsslPaeasrr/Sere Narsc <br /> 1t ��S��"�►'��,� Q� �U l�I/ <br /> 5rre600 0 ' mare x Oua:a�>Kot+e <br /> c:rr IS-to cv-u fo aQ <br /> Meiling Address ifDZrANEW banrird/ityAdWew Attention:ar Care Of(optional) <br /> hlallinp Adtlresv City �> Q ,+ „ ,, ) ST�tr� a.` 7 <br /> TtitltD *ARTY ISILLING INFO: COMPI&e if 8pEling Party isdiffel tt from Property Owner arFacility operator identY Batu <br /> Busmrm NAete AttRndont orCare O/ (apGntae/) <br /> ManilldAddttass Pfwna— '_ <br /> LYtr Snag zip <br /> A � yrz$t s <br /> for secs and charges OWNER FAciuTy/BUSINr99 TRWO PARTY SkLUNG <br /> asatt�■ar■ r.n■aa�aahtaa■■a•ar ■ w+.�i r _.---_----- - .�•• <br /> ihLLINC MG und.v5ir1ed,ArplitA4r,a rtih+At S lm to.O.A-,Oprrnmr,or awelortzed Ajana otthis Stutn se,as 3cttaaateeet�rat zO Priewr lam'. <br /> P4naznrs,,QVMRCHarRNr CxartGW and/or,ti'QURLYC'JGtnses nftocimted wIM Otis opmndan aftt tic billed to ma at the addmq idenn&d above is the: for th:c r+r• f alio certify that <br /> ib in(artmation Provided ea this apphoo0on Ig true and co—t-,and that all tegtdafed activities will be parftymed in azrardmrz wdh k)arika T QM Caumrr 0, mays Cadet andlar <br /> 9mndatdz ua0 9r.Ttt tnd/or FYDtRAL Litry sail Rrgviadohta .ai rte UndersiQshlsC Ifaotr,apenror,or:gest as she yrnperb tototsd et the aDavm gid additive I6treby a,dsor4ae the tEltstsc of <br /> soy and ad emits ane mvimn�nngtal msusment tnror,oAtiaa w SAN JOAQUIN COUNTY %rfMGNWNTAL HFALTH D"ARTMENY a i if iso mud t tnc same time it IS <br /> prodded to at or may f omentssirr. <br /> PtEA"Plane <br /> APPLICANTNAME i <br /> AIAA7U <br /> lUsp /a � j <br /> 4-Nr <br /> TIriE °a� m >rnanp2sy — <br /> _ <br /> - — k� <br />