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LFR �ax:5106524906 Nov 266 9:24 P. 01 <br /> San Joaquin County Environmental Health Department GREEN FORM <br /> OATS �l Q D,/a MASTER FILE RECORD INFORMATION TTMFRFJ <br /> IIr <br /> UNIT IV <br /> OWNER FILE DLJ DOD MJF OWNER ELAAFNnrarpMewm/END <br /> 77cfty <br /> N. <br /> AhA: Ptd "�!ea <br /> LT5WW/TAxiox <br /> Ll � P]o + or <br /> drwSTATC ZP <br /> OT Moiling AddmsA (PI 5 <br /> Melling Addrea Cny L <br /> CwwA.WnQ INOMwAL❑ PAmsmvF®❑ Rm AdOlcv❑ OTKrt❑ <br /> FACILITY FILE <br /> ^n' F <br /> Is Ma NEWUSIMM LO MON notprcYlou54yregulatPd bythe ENnRONMENTALHLUi btPARTMEM YM 11 No El <br /> 6 this an rnsTU o Busl Nws LOCAnOm Mit a NEW TYPE of roquLuad euslness7I YEs El No 0 <br /> IitJ9NL„lFArJLtlYf9yFNAFie <br /> Lin� v� (� L'sy.�j1&,N <br /> Aa,fiL1FADOREC6 pC,I.T L r— {.� VY\I SOOT.# BIFFaePMw <br /> G. Y\ <br /> CITY STA111C <br /> n <br /> MiIMn1 Mdl'e95 NDJAEREM�'q�+N FACINWnyew Attentlon:er Ont Ot(dGdunsO -. <br /> Id+mtq Addrtas"N" IzL VY-1 •'ti� $iAT[ Em C'�DI <br /> , 7 <br /> THIRD purr 131LUNa INFO; Campkie rf BIIIIng Party is dlt/erent(iom Property Owner orFaCllity Operator.iYentilkiC above. <br /> Blrr;aEss NAME 1 Athrltfonlordre Of (ppdOM0 <br /> MAIEtq Adams �, 1` O Ota I l-. N' F'Oq r w <br /> m'for revs anddlalges QWNER FAOHRYfButilwasS - THIND PARTY BII1lNG <br /> g — ;r..rcA vovnsmvrwr. hthc underdened Applin.,,artily that l Am the On .Opopmr,pY AafAWIJM AbT^l of thleHudnas,.M l t6nowladta that 1-PMrFEC£ <br /> PEWJnsf,6xFpx2N£MCNAKJV Andlpr Hauw•v(FrdAOFr aaadvred with lM1if apenDnn will ba piIlNl la me M Nr eddrry idea{IRW Abave a Ne dLLaINL,dpC°i—far!hk rite 1 alto rcr4(y IhM <br /> all lefmmAN.n p,ad,d.n thio Appllallan b mua and eorrren and t 6(.11 M.Isted.1i will he performed ix affordanae with o ppBut,k,"JOAQUIN COUNrT Ord;. re Cotler A.dl.r <br /> Sraadarda and SpA'to fndnr PCpnMLLaw.rna Re`pNtie.x Aa Ncvndenitneu oweenap.*+wr�or fgefdaflhepmlany b.'tti a beve fadCgAite addreft,lherchr.0 riv�therdestlef <br /> ARY Add.11 roulw mN <br /> and envirpemuj usermrwl I. rnarrow n BAN JOAQUIN COUNTY ENVIRONMRNTAL HEALTH DEPA ENT n roan u N e AvoiHhk and A he fAma time it if <br /> pteWel w me ar my mpreemtAtiva _ <br /> APOLICANr NAME �ASd�„� Tr A SIGNATURE <br /> ZL— <br /> TruDRIVERS NSEe <br /> APparsA <br /> or nacre AcmaxNq Dnipe iNotanrpgCampltNed M nMe <br /> 29-02-002 AP625,2003 <br />