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` �.- -J Rev.6/26//2001 <br /> Page 5 of 5 <br /> Respondent Information: <br /> L Name: JAnIGe- Colombinl <br /> Title: ce-owner <br /> i <br /> Firm: <br /> Property Address: 4-79? E. M 0,t'n Sf <br /> V <br /> Mailing Address(if different): I4100 E. Sht Fo n <br /> Llnden CA 95a4k <br /> Property Assessors Parcel Number: ApN 173 a 1 U 05 <br /> L <br /> Phone: �aoq) gg -3 3 38 <br /> CIO <br /> Respondent Relationship to Site: Owner Occupant Renter <br /> Type of Property: Commercial Industrial Residential Farm a.n <br /> Preparer represents that to the best of the Preparer's knowledge the above statements and facts are <br /> true and correct and to the best of the Preparer's actual knowledge no material facts have been <br /> suppressed or misstated. <br /> User's Signature Date <br /> Preparer's Signature Date <br /> aa� -03 <br /> Pldpondent's Signature Date <br /> P:U916 East Main Street Development (Grupem916 E Main Street Development Phase ]\Correspondence\LettersThase I <br /> Questionnaire(-05).doc <br /> Initials <br /> 4 <br />