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.inac> Cs�uSanwa Stanley L.Olson „ u <br /> ,C.P.M. <br /> MINN.- <br /> , <br /> . .......... <br /> Bank Vice President Fops (EHDUta(REVmeaotWs9T) <br /> DATE JUI. / (1 ZFJG p <br /> California Bank Real Estate <br /> UNIT IV <br /> Sanwa Bank Plaza <br /> 601 South Figueroa Street <br /> CA 90017 <br /> COMPLETE THE FOLLOWING BUSIN Los Angeles, )wNER CURRENTLY ONFILE WITNEHD <br /> .................................................................................... 213/8967149 Fax 213/8967080 ..................................................._............................ <br /> BUSINESS `: .1 E-Mail:solson®Sanwabank.com p <br /> 54ii w at NE n[ <br /> ......OWNER NAME ____________. Zt3 9 f6' I iA9 <br /> ...................................................... <br /> F2(................................................._.............._.........................-........................................ <br /> BUSINESS NAME(If different horn Owner Name) 6ee9ecY TAa ID C <br /> a`M H ; SfavT Q15ovt , V,Ge P+eS. <br /> OWNER.I1pMEA00RE53 /O' /��//),.• A /sem (�11_ DRIVER'S LICENSE Is <br /> Chi' L ✓��1EC�L �7i /t STATE <br /> o CA LP G�t� <br /> OWNER MAILING ADDRESS (ff0/FFERENTfrom OWrrer dr <br /> Adess) /T Attention:or Care of (apbonali <br /> Mailing Address City State Zip <br /> CORPORATION INDIVIDUAL❑ PARTNERSHIP❑ LOCALAGENCY❑ COUNTYAGENCY❑ STATE AGENCY C3 FED AGENCY CI OTHER <br /> FACILITY FILE <br /> FAcaiiTy£O# a.A� ORass�itEP£O# ACGolRiF£O#6's..` .'Y <br /> COMPLETE THE FOLLOW/NG BUSINESS / FACILITY/ SITE INFORMAT/ow. <br /> Is this a NEW Business LOCATION not previously regulated try the ENVIRONMENTAL HEALTH DIVISION? YES ❑ No Im <br /> Is this an EASn NG Business LOCATION buta NEW TYPE of regulate!{B�usiness 7 YES ❑ NO AL <br /> BUSINEsS/FACILITY/SITE NAME �' `� t/ Fib �/�T-G.-CITU <br /> iz 696 Locicc Roa-T), <br /> SITE ADORESSSUITE 0 BUSINESS PHONE <br /> I Z6 $ 6 LycLcE ROA,( AICYJ6 <br /> CITY L-0 CV <br /> „C, /6t�t�`(`n IJ� STATCA LP Ci5Z-3-7 <br /> Mailing Address if01FFERENThoosFacffffy Addl ressAttention:or Care Of(oadianall <br /> Mailing Address City STATE i LP <br /> l slcfxuExx, IaPak# Nr <br /> THIRD PARTY BILLING INFORMATION: Complete if Billing Party is different from Business Owner Identified above. <br /> ............................................................................................................................................................................................................................................................................ <br /> BUSINESS NAME 1�-�-� y. _ v Afteryion:or Care Of (options/ <br /> 9 +Fye. "I ft.YT�)PQ4 TOS K <br /> Mailing Address '/ . D. S7 z)X cj 0� -7 D PHo <br /> IQ <br /> CITY l I IV' J ✓O / (p STATE 7JP <br /> ACCDONTADDRESS for fees and charges OWNER FACILITY/BUSINESS THIRD PARTY BILLING <br /> BILLViC.N'O COMPLI.VNCE ACIG'IOWLEDGME T: I,the tm a Applicant,certify that 1 am the Owner.Operator,or 4whorged.4g,mt of this Business,and 1 acknowledge that ail <br /> PERMIT FEES, PENALTIES, ENFORCEMENT CHARGES and/or ROURLY CI GES associated with this operation will be billed to me at the address identified above as the 4CCO(/.NT <br /> ADDRESS for this site. I also certify that all information provided on this application is tree and correct; and that all regulated activities will be performed in accordance with all <br /> applicable SAN JOAQUIN COLNTY Ordinance Codes and/or Standards and STATE and/or FEDERAL Laws and Regulations .As the undersigned owner.operator,or agent of the property <br /> located at the above facility/site address. I hereby authorize the release of any and all results and enntnmenal assessment a' t AN JOAQUIN COUNTY <br /> ENVIRONMENTAL HF 1LTH DIVISION m soon w it is available and at the same time its provided to me or reprew <br /> PLEASE PRINT ® i' m.iv <br /> APPLICANT NAME �T� �n— � SIGNATURE <br /> TITLE �. Y�5 � J wA4 ' A-A)aC �iiF DRIVER'S LICENSEt <br /> JPMr1Tn(`nPY RFrll RLmI <br /> LAP ay Data AoeDunting ORIGe ProeessmgCompletes 8V Date <br />