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DEC 17 2004 17:2G FR EARTH TECH 4082322801 TO 91 9486022 P.02/02 <br /> San Joao County Environmental Health Dep ant GREEN FORM <br /> DATe �ec- MASTER FILE RECORD INFORMATION "MFRrr <br /> sd.D enwrs ..� ,u�Aol177b . . - UNIT IV <br /> OWNER FILE <br /> o+rrxte OWNtTI(yau2nnrpnARr<wrm EHD <br /> CVAf E 11 <br /> LLowmG OPERTY OWNER INADAM-7lON.' <br /> PACPERIT DWNN2 NAaIE GLEN E PHM (209) 931-1571 <br /> FATE AN Les} <br /> B�anlrs,'tarESocsm/TAttiG e 94-2556864 <br /> Airport Land Ca. : a California Limited Partnership <br /> OMWSLRa®EA <br /> owner Name Address P.o. Box 10 <br /> ST"Te CA Z7 95236 <br /> crty Linden . <br /> DNhwrmallinaAddr= P.O. Box 10 <br /> Misift Addmde CKY Linden Sem CA Z%' 95236 <br /> �ponA>TDf1� 101I)WgeAL❑ TLimited PAInNindoem ttAArAac*O OrAR❑ <br /> FACILITY FILE <br /> FAa dD# (1:058RITDA A= N /_ <br /> COMPLEZ rHi82 NTNG RUSxlYESS I FACILITY <br /> is"a New 8uaindm L=77(m not plriomly regulated by the ENvmoNMrJ'rrAL HEALTH DEPARTMHNR rsc 13 No <br /> cN <br /> U 111s an SC TIi NG Busiiness;LOCATION bale 2 NEW TYPE of reghdated Blainew? Y6 ❑ No <br /> Bv[ar�ss/FAm-TaT/SneNANE01ATyCD £leCTv"C5 <br /> S X BUSINESS PtIDNe <br /> Sm ADM F:6L,Q A%M WUt^ <br /> CRY E � S1R,E LP �L� <br /> P�: 13�j3go.o3 <br /> Mailing Add1aas JrDkTfgrevrAvm ib,;WyAR(Aew ALLstelorc dr CwsOf(dldEra/AW <br /> Milling/ddra"Cry ID <br /> T141RD PARTY BILUNIG INFoe Complete if B11ing Party is alperLpr I m Property owner orFaci ity Operator identified above. <br /> Scows NAME ARe71COR:orCare 01 (PpliamaQ <br /> Earth Tech s <br /> Mailing Adam 6015 PHONE <br /> cm SA-0 CA 13L/ <br /> --tea fur fees and charges OWNER FAaLryfaUSINESS THIRD PARTY BILUNG \ <br /> ....._...�-�.... ... .rnYmvisnrwr.r 1,me unJcnigncd Appllennr,ceAlly Huhl em Lh±Oreo,Operatnr..rAarhorrrN.lrrnt afthis BRabtal,.-nAl a2Tdlnn'Iedt[-that-all'f3ylsr�tT� <br /> pOyy yaps•fT'1'OA[aHfT7 fknec.nJ/o.NOUW.v rXaAaC.r nKociateJ with this eper.doo wig be billed Ie ae ns Ibe.ddrwt Id.n�:ded.be-[es the Arm Tn,Inerrra Pae Ibis elle I nim er.ITIN tbsh <br /> ee infarmAnan Pravidrd on this,apprwmm 4 true and and eh.t MR M vhled Atl:wlio,nll be periortnd in ermrdonw with nil aPPllrnhle SAN 10A"County ord'mnerc C""and(er <br /> Sb.d.rds and STATE Andler pm6tUL Laws and Retulorknr. ni M[and<.wFn.J.rnm npmter.eHr[nl d the Fft "looted nt U•ebevA taeiityldleaddRss.thereby avdfaeite the reload[e( <br /> .vy end eR raulb and ovlrpnmene.i aaeasm[nt informntlen In SAN JOACUIN COLIKIY ENvfRONMENTAL AFALTH DE ARTMENT at en is h it iv,-R2111 m nt the st ee nme II h <br /> pn.:Jed m me er ray tepremodva. paw, <br /> APPLICANT NAME (pI`Aq STGNATUR <br /> _ �A AA f� d� C-' 1` I <br /> Tate roftmoaor ain <br /> AL <br /> eQuu®) <br /> Appllred RY eata AmbUllellp OIrNC phpdsdnp CnNNetad rn Oats O <br /> 29-7.1102 gpnl I5,2003 <br /> TOTAL PAGE.02 RN <br />