ze•d �dlol
<br /> San Joaquin CoQunty Environmental Health Department GREEN FORM
<br /> OLJocl3 4-2-6
<br /> DATE MASTER FILE RECORD IWORMATION "'MFR"
<br /> 1,r UNIT IV
<br /> guopnJlrrsa.os � ::.f� ::��"iti•e � h x,.iaR IeF,7W 1.7�'^"II"Pp .
<br /> I ', I
<br /> OwNE9k FILE . p&mr� OWNER aoff'WMYr FXJlbWM enD
<br /> CIpM 6 LIOW/NG O INNER NPo ATYO
<br /> rXOXE .
<br /> petoeRlTp KNJNE
<br /> I flrSf
<br /> M1 I.aAf P.C7 — s
<br /> $OCEEC/TA<IDs
<br /> pRlvLa'Sf-s�se i. '
<br /> �.awmvn9m�Aedrass Z3rpp P�5e.7' iJ 2a!#I�
<br /> nxm m gs3o/9s�S�
<br /> CIN T(C G
<br /> Orarer McElrrg AddnYJ
<br /> Mailing Addratl CAy
<br /> CONgnrtLa,o 2XEWm11M,❑ pAATNiKNIf❑ pEp,NdSNCr❑ vmN117
<br /> 1(a S 7 I FACIPI Y FILE y�zZ S
<br /> �Jy'�r,��r�I� ppryi:,' I: �' i.I rl�r uijl,T+ y 1 u11PJl rl i,r 6 I b191d[' t � � q1• i L r79 .
<br /> f 9bS— ' �"j ��� � IJT'�r' l• 11.�J` "1I 11V �1_.•I Y �� yH���l I .L:'. .:1 :IIR�.fawn:
<br /> is T71isa New Budnm LOGITON nutpTeviduslyregriWLedbylhe ENV=NA4WTALHEA1-T14DEpARTMEpm— YK ❑ Alp ❑
<br /> Is tlls an'p¢znf%WsSrlast(pCATION but,NeN TYPe d regulated Buaness7 .
<br /> YES Q No 0
<br /> s»IFx�n/sTe HANE D$il�l- VO[iq•i Ic9n1A'� .i—��T f'TL�Tt: .
<br /> s,TAppa�S Z�,��rs JLA55o n.5 d?vA h -
<br /> T�cy srA,fCA� m'953o�(Rs, Fs
<br /> ,:�. ;.n,i -l�r::1,;'.,1.,.m...,' t.,.i.,t.yr,.p: ' ;:J•-�a.'NyIh1;:S">"c�.^,,,�;; . �:eli�,ie;i.a„k; r„i!.Iti,:
<br /> 'Cjj�l .1 ” -yo 5',. az rrJ , � *4 „I R” I -, C�Im`SI Yc: lal " �1 ��"l'dr6Mi1111 J.1� il:t.; C79'I " :ball. [• A':
<br /> r.l
<br /> M
<br /> ;'v.",.. -
<br /> Malling Address/AIV7t7tliyrihmFSoFfyAOPrerJ ALLenden:er Gra Of(goel7r+a11
<br /> SPATE m
<br /> MagMng AddfmatlN
<br /> o, 7I •.VI�.::: 'r ;a v rft 9 f qq� .Hr 'ar.8 C1'{'7;'
<br /> ,Pr 1pb.�l� '1`� ::.'' �� � S: IE1 1� 1,"T SF FiIIi :.:.a� 31 w'Y nla.I:tS �"';, I �If ..t:yl^ry.;Y:..l;•,�I.V�'
<br /> THIRD PARTY HILLIXG INFO: ComPle&Y Billing Patty 15dh9emPt fmmProperty Owner OrFadlitY Operator;Fend(!above.
<br /> AS9BnC9n:a'Gre Of (qubm"90
<br /> gum.=NMI
<br /> MJ1Iing Addmms {r9Go 1i3R0/t O.`Je&ry STS• 2.c+r' P"X'E Sl0=�.6£s— p`lb/ .
<br /> OPKc�T �D sraie ��
<br /> CE `�ybo
<br /> -A Q,q.,,M AlltoBm far 144K and charges OWNER FAGUrYIELSINESS THRP PARTy BILLING
<br /> .. wr�.riexrwrFnr`M¢tm E,dw JAdervppN Appllern4 eeruq that iMh dw OwJrf,Oprrv°r,^r Anfhw:u/Apcnl of lhk auaJxrr.and l+'l^Per dhesit.I a ro Cerds�Y
<br /> Puk,t>�,eworXENrwa+A^cr�Jndfor Nfwlur CM.pICeTJveerd ailugrrt w Ieeu+:jon Ten wll hee pe.,owd in sword Wilk All ppneohle SO 64ONC "Ordin..ee Cada.eelo.
<br /> All Iftf4,.6ue p.,Wd ae this epplialen h tree end wrnst;e a nbr.er edtlAG prppeTq Xeenlxd JrNe e6e.+hdllrT add i .bn ledwrioe rhr rdrnre a[
<br /> Srendp06011d$.Te ea'Iry rbGIAL Ism xnJ Re[4hrrm.M IM uAdee+Ip116t DweYh M ^�^
<br /> e^y Jud en moth seg,11jr m Am tore A rJr inOr"oo'µ1n w SAN 10M1OLi1'!(`OONTV EN'VIEONKEN�AL NKA4'rfi pSPARTME a e. e s w rt^sen ar mx s.me oma
<br /> .prowled re mx NA ripr� palf
<br /> SIGNATURE
<br /> aPPLlCAXTXAME
<br /> TITLE , (MOTU�TII Y
<br /> A n,alprommkip cm0»w By Zito l
<br /> 29•n7.OM A,if 25,Pffl .
<br /> zOizO'd SbSO 89E OTS L •JNI `1S3M miond Oz:9ti SOOz-22—iDO
<br /> A
<br />
|