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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 />