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' Y <br /> r <br /> San Joaquin County Environmental Health Departrient <br /> T DATE 7/11/2012 MASTER FILE RECORD.INFORMATION"MFR" GREEN FORM <br /> SITE MITIGATION&LSP <br /> _ OMEN ID/ CME N 5083782sRn d0 S30 3 UNIT IV <br /> 0M _R F&M:00AWLEw MEAOL.LO WNG PROPERTY OWNER#"RMATim <br /> CxEtrxtr O'WNERCIAvtrrrentraNFtLrwrrrr EHD <br /> PROPERTY OWNER NAME Pat and Kathleen Meeks <br /> _(?09) 366-1100 <br /> .FbI lLfl Last PRONE NUMt1ER <br /> BUSRNESSNAME - _Meeks RV &MAFLADDRas <br /> meeksry@aol.com <br /> Owner Nome Address <br /> 783 Los Flores Court i <br /> City - - <br /> Galt eT TEL 95632 <br /> G <br /> Owner Moiling Address <br /> Same <br /> Moiling Address City - -state <br /> st to :$-.. <br /> CORPORATION❑ INOMDUAL 11 - - PARTNERSHIP❑ FEDAMuv© onm I].: .. <br /> Sats MIMMATION_MNYNlONY111BAL arr_VDLONTAIIY CLEANUIP SWER QUALWY_I W PIPZUKE INYCM"V10111—LOP .X <br /> 1 <br /> FAOILITY ID f IN --- - A000uwr Id Pq alR.O E Hwo <br /> o Wa4 :r, rvF.ixr� :lS�i � c' ;�' fir• <br /> msffl� <br /> FAIralsr"FRZ 11304 M71YEFOLLaWNeBUSINESSIFACILITyIarrELwol<mrfTION., <br /> Is this a NEw Business LooArON rat pnrAm*regulated by the ENVIRONMENTAL Hr-ALDEPAR'TMEMT? Yea ❑ Aro � �I <br /> Is this en Eximma Business Lownm but a NE 7Vm of regulated Business? YE.+ ❑ No ® � <br /> BUSINESSIFAMLITYRIrm NAME Meeks RV <br /> SrTEAcURE88 SurrE0 SUGINESS PHONE <br /> 25355 North Highway 99 (209)366-1106 <br /> Acampo SCTA ztP <br /> 95220 <br /> BOARD OF SUPERVI1001OM7R10T LncATIDK--CODE - KLv - .. -. _ NET2 . <br /> Yr <br /> Muffing Addrsas ffXFFERENrfhv"FacAW Anitrow AfEentlan:arCw Of(opfibr W) <br /> Mailing Acidness Clot STATE xip <br /> 910 f;.ODE - APN tie " COiMAENT; . <br /> OOSI� 3oz r. <br /> 'r UW FAllarr■:La1Nts hOM Complete h►Bifling Party/e dWerentfimn tTperfy Owner or Fac IIfty Operator Ideniffled above. <br /> ... -- <br /> BuafNEea NAPE Att/ntlan:or Care or(Opamnal) I <br /> Cardno-ER l _ IfL <br /> Moiling Address 601 ,- <br /> 601 North McDowell BLVD. (707)766-2000 <br /> Crry Petaluma STATE CA LP 94954 <br /> I: <br /> for teas and charges OWNER FACRR7YIBusINE33 X THIRD PARTY BILLiN6"X <br /> BILLING AhT_CQWL1AMXAQjMnMMM: 1,the vWmljnW AMMemk ar"that 1&to me Own&,Qjvra ,w Am arfize,d Asmi or tib BminesL and I aclmontedae that&U FzmvFm,' <br /> Pen LnF4Zvroacatra"CX4&C c4 adlor H0vmFCm4RG=aaeoclaled v/M lith operation wM be billed to me at the addrat IdentlRed abaft m The�tcy�ciPpt �Aan�g�r far this site.1 aha certify Hot all <br /> Falbrmmtian prwWd mt tth applkadw Is tragi mad t&md;mod that a9 regWAted methith!s will formed In be peramardante with All ippl a Jo ulk COUNTY Ordlaance Coda and/or <br />' Standards mad STATE and/or FMCRAL Laws and Regulaticm. As the arAknlDeed owner.apirAFOr,or agent of the praperq lted at ve faeflrty &ddrvm:1 hereby aaftrla the relew d <br /> any <br /> and raalta Sad envirawnenal momment informsihm Is SAN JOAQMN COUNTY ENVIRONMENTAL HEALTHoca.bEi' ENT ai m It Is available and at dw game d me Ft Is <br /> proAded to me or my rn"enattve. <br /> APPLICANT NAME(PLEASE PRINT) Jim Donohue 31GNATURE - <br /> k <br /> TITLE Sr.Staff Geologist TAXI 3304U3154 r <br /> ApT►ad flDatA AacatnUnp tMlies ProodsarnS Comytafad B --- - ,Date va <br /> BITE MrriSATION AmouNT PAID DATE OF PAYMENT PAYMENT TYPE REDEtr S tiNECN dl •RECEtveo Br i�11iORiS p r- 4 <br /> FEE: <br />