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09/19/00 12:33 FAX 915 991 j67 <br />09/12/2600 09:18 209468 Eric Jenks JTF 0002 <br />r FIFTH FLOOR 54(05-9 35- PAGE 02 <br />i <br />nATE /p _19_� Z MASTER FILE RECORD INFORMATION "MFR" GREEN FORM <br />KO <br />ry c a "w'i <br />faael+naeeON� UNIT IV <br />r u <br />OWNER FILE <br />;OMPLETETHE FOLLOW/N".;PROPER Y OWNER 1NF0RMA'//0N,' CHECKIF OWNER 0tevaEAFMY6NF14aWrHEHO <br />PROPUMOWNER- IIS -�fl , PHONE <br />HAMS O AV PN j LU2 T 1 l' �j.. C. Ct I qq I' S <br />FW MI L,st <br />BU91rtE5S NAME �. SOGStEc lTnht ID R 0h ' or c r Fe.f 1 z e `� L <br />OwnarHdme Address C- /P, F r- �Lf._ :Y -P- DRIVm'S LICEwsF-# N 1 <br />City $rare L2tp II <br />Owner Melllnp Add— <br />nlailinfladd>aasatyG�Cfc�\Me� �, s> C0 zh' 58�; <br />I <br />FACLLIYX FILE <br />COMPLEMTH,,5FMWW/NG BUSINESS I FACILITY 1 SITE IAMPMA770M. <br />fs this a NEN Budinese LOCAITON 1 Otpreaionaly regWated bythe ENVIRONMENTAL HEALTH DMIMON { YES LJ NO /� <br />la this On ExtsTIN¢ BuaineBs LOt ATON tints NeNrTYPeetrngultitcd tludlnr3a ? ws El No �� \J <br />BustW�ssJFAelutvrBtTENAME <br />SrMAODRE35 SUITE#� / BUBINE=PHON '" ) <br />i \_ <br />STATE zip <br />J <br />II: Attantiow or Care of (ophionag <br />Mr. Eric Jenks <br />John Taylor Fertilizer, a subsidiary of Wilbur -Ellis Companyr <br />Mmlii PO Box 10 103 O <br />r. Marysville, CA 95901 _ — <br />-lid _ - —.Il �f <br />THIRP PARTY BILLING 1NF9`a COMPlsie if <br />SUSINESS NPAr <br />Mailina Address <br />Attention_ orCare Of (opfionvo <br />PHONE <br />CITY I STATE 13P <br />above, <br />' CI_OUATAPORESs fnrfeelb and charges OWNS PACILITYrBUSINESS THIRD PARTY BILJJNG <br />RMLTMG . n CnMM.IAN r. AeV.WthWILgeo?JBNT; 1, the uadersipM AppBrsnt, terrify tbatl am the aurcr, Opeuyfor, or,indwrivilARene arrbts B4oinesa, and I nni—mledge that aft PFRAt17P8EC, <br />PPMrlL7TPSI ,ErvWORC8Af6NT CxarrGttf' a�n"dlor IYOV.4LYCNdxces assotlaocd w th cith optm*)n whi be b)Ilad w me at tho addrexs identiQat mune as dm CCOrA*�'nnnMS for this site. 1 abo ccrffl'y rbar 2,11 <br />Infarmadon provided on tWs appli-apon 1s pua and correct and that xp rephttd activities Vill be pcllOr+ned fo accordance with all 2,ppvca to, SAN J0,,Q1J'K COUNTY Ordlnnnae Cutoa and/or <br />StRadnrttS alyd STATE amlfar FEDEnAL La,r! and RomdatienL As the nnderstgaed awn- , "cn+ror, er uergt arrha praparty rucnted av rhe abo a I wilityNtu sictdres, 3 hereby anthmim the rtltise of <br />aey and at results and r ironmcntel U0Zutncnr int'ormalfon to SAN JOAQTJM COUNTY ENVI tONMENTAL HEALTFI Ptv1STON as saran m Ir is wailsblt and at the sift t9mc It 14 Dtpvidcd to <br />m- army repment2tive. <br />Pt,sAse �wrir <br />APPLICANTNAME qac SIGNATURE <br />CRIVEit'SLIdENSEtF <br />„tet'` 1'��7R� vt+arvco¢r�atlla6c <br />r2 313 .. --- -- <br />' '' __. Q �D os� y` � DCy } 3 h 55f66•1,1�0 � � hNti, <br />