Laserfiche WebLink
r — <br /> San Joaquin County Environmental Health Department <br /> GATE. _ ' MASTER FILE RECORD INFORMATION atMFRit GREENFbRM <br /> 1 --- -. SITE MITIGATION\&.LOP <br /> 5 � ��"YL4C DYMEfl too .... CASES -.. UNIT �/ I <br /> OWNER FILE:Cagpters rHEFOLLOWN=PRO PERTYOWNER/afFoRmArloy- cIYEVx/r OWNER c„flE„a.oe.,:EN NERD O <br /> PnovEmY'OMNPAName_ Jar} 0 `{t <br /> f .Fhst M, Lam PNONENu <br /> -- NEFe {{ <br /> BumxEmNAMe lvt/ti1Gf kCf t E+1AILAOORE9e _. <br /> f armPr, Lan �Gn. Q i /1V if 0/h <br /> oainarHPmaAddrsrbv - - - •' <br /> ro o 146 <br /> DHy Maa�eG _ <br /> STATE _ j zip 95 336 <br /> Drone.MalnrdiAddreao - - <br /> Sable 175 moue . <br /> 61ate zip <br /> { cosroxpnox0 txoMuwL❑ PamxaionPO FioAaoxwO mNal�' <br /> I 'SRC MITIGAI tON_EMNRONMENTAL Afla dusiet Nr,_VOLUNTARY CLEANUP WATER OUMM HW PIPeUthe INIIE6TIDATION_LOPy <br /> i. ... - .... . <br /> FaeamlDd tercR AeCPUNT IOI 1 <br /> PR eIROa AaelexEli ENPLPYEE LEAPAomoY:EHD_RWQCB_DT$C_EPA <br /> _ <br /> FACILITY FILE COWLETF7HEFOLLowNl;BUSINESS I FACILITY/SITE INFORNA77C - _ <br /> Is this a Nm hostiles UMMN notpretedisly regulated by the ENVIRONMENTAL HEALTH DEPARTMENT? •YEsp Not <br /> Is this an EiisnNG Business LOCATION buta NEWTwis ofregulated Business? YES ❑ NototBI <br /> i, BuamesslFAcnm/6rreNanE- fne reDl" <br /> 6REA0010:99j': �� 1/- .BVREA ��x1E89PNON6 _ <br /> O 7� ? 3�0 <br /> 1 �(n Y O STATE ZIP <br /> 60MOOPSUPFaV1a0aD1arIVOT LOPAMN COPE TLEYt REY2 <br /> Malting Address ffD/FFERENrealrraclBtyAdd/ . . . Atteneon:m Cme Of foPllanP9 <br /> Ma11hng Address CHy 6TATe 7m <br /> 610 Doee..-- - - APNe <br /> THIRD PARTY,81LLING INFO: Complete it Billing'P,erty is different from Property Owner orFaotilty Operator identifiedabove. - Illy <br /> r Buemem NAaeZ AfienUon:o <br /> rCan Of Apthaw <br /> 1 Vat1rP n a <br /> S MZIIUIa aedres9 PHOxE. <br /> 25,215- <br /> -4 <br /> 30U <br /> 1 Drtv i LVL 7'l STATE,CA 'zw -IS,2rs 1 <br /> j f <br /> ACO¢UNr9PDBESf ror fees and charges OWNER FACILM(BU61NE65 THIRD PARTY BILDNG <br /> I <br /> Pn.uNC w.vp CPnmuFxcs:Actwmst[erstcrrt:'0,fleumleMpned Applieangcrxfr lhol l Am the 0imen eprmrar,or AviAr+rzed AFrnroftM1b Business.and l arhnnxledle that an PuVa Fm i <br /> /'EYItnP$EYIParEVEATCNA9LEa amVor/lo[mITC/,.uGfSaswdaltd nith Ibis Operation will be,Stand tome a,list oddrra MenNlled above As IAe Arml9TAPoaeSS fee this silo.i Is.catitp that <br /> all lars matlon provided on this appeotwn is true and tormet;And that all regootd whiffes em be per..M U maormna with all appikable Sm de2QP1F(70uhnw Oldmasee Codes medlor <br /> Sw dONs antl SPTT and/or FEnl:ML Li s sne Rtiv4tlo ls.A,she mnleral,ed owmr,aMn.wq or atom of the Property located at the shove Taell lyoot address.I h rob,anthorlu the release of <br /> asltl eli ream) M.,I nmm I s mtdt intorw 11 to SAN JOAQUIN COIIN7Y E"RONNJFATAl.(HEALTH f1EPAlYTYt T a s n As h h��d at the A.time it is <br /> pwrided w meon.,ren-riunmthe <br /> �Slatla DF Jgnzs I'1 Lar.y. k <br /> APPLICANTNAME tPLEAm VRS Y) sasNaxit. 4 <br /> ( ( ] 0 i. <br /> TITLE TAX ID <br /> E <br /> An,am,nadB Dew AacaanP emva Roaw Cam lmeAd <br /> ""MTokit, 1 ANOVMTPp10 DATIOI PAYMENT' PAYNFbTTYPe AEPfl.rd DHeeno IftweNen BY WORN P4NPE. i <br />