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Oct 04 2006 13: 10 �USTRE-CRL FRX p. 2 <br /> DATe 10D(� <br /> San Joaquin County Environmental Health DaME <br /> b MASTER FILE RECORD INFORMATION Alm <br /> UO IT IV <br /> Cwrt=ME ENAR lJ�(���'i.i <br /> ONFLETETrdEFOILOWD�PROPERTYOWN INFORMq eYkrrArl®E'Wn*END X <br /> Plelia[TY 0R NM% <br /> VIPFR <br /> 800-234-6264 <br /> suaaAaa NAHe Lustre-Cal Nameplate Cacpo,T. <br /> dt10ri Sx SLC!iAx ID a <br /> ownerrAWneAddnm <br /> M1Ud[0.Y LImvE Ar <br /> city STATE CA ZP95240 <br /> Qener <br /> MaSaq AtldlW CRy O > 0.A L , <br /> C('RPCAAT INDiVIDIML❑ PARIgR9nP❑ F®AiHICYO <br /> Ornee❑ <br /> IrACILI'iY FBI! <br /> FAtH3rttN i E r qN1-'� i i4 <br /> - �Is�l'� •=`n�1',c r S kl�fax .a e... 43. s+ . <br /> u this a NEW Business LOCATIOtl nut previmsiv regulated Dy the ENVgEON1ENTAL HEALTHDEPARTNIEFM YEA no <br /> Is U*an E1Mnm Business LDrATIGN but a NEW TYPE of regulated Business? Yea ❑ No Ar, <br /> BIaByE3PlFAmnYlSlIENAne Lustre-Cal Nameplate Co ration <br /> SM AAOPctt 110 East 'Turner Road Surrzp <br /> ��g264 <br /> Cm <br /> LOW STA P j p <br /> �,. 95240 <br /> 1 .,"..: AI 1 i@r1t ,c I m Herz - <br /> NaRrNAddrasNORAFERElVryiarp PoN[yA&%w IA}aen11or1:a Care Of(dpfdwya/f <br /> 715 South Guild Jae Ho <br /> Lader <br /> Naihag Addn=CNy Lodi <br /> hgU <br /> STATE <br /> «. CA zip 95240 <br /> 5 � ��. �rl��i- � yC A`•. 'W�ri Rs Y�it - <br /> THIRD PARTY BILLING INro: Comp,'eteif Billing Party AIs difTerentfo Property Owner or Faeil' . <br /> auswe%NATE ILY 01)ereEDr rtie.Yltlfred dfAYe <br /> Asbltion:drove Of(gpOFmWf <br /> Maiiing Addles PIIOfE <br /> aD <br /> SpT! ZV <br /> I®Y®5.000Btg for reef and charges OWNER FACILRYISUSINESS THIRDPARTYBILLMD <br /> n,�i rur grin t•nv. a e - -- ��-�--; E rte imdersignrd Appinun4 mNry Wet I sn Me O�wrer,O;oder,or ArtbvrWdA - <br /> P[N.u.rrFs,F.vrnREKAT QIAM.ASpnd/9r NOc%r GylacraysAe[red wUh Wu 0 genldnlb Bu>mru,and lackuwkdee Mvt vll Psuut'ATq <br /> opnadon MITI k Ill{b me al rGe addres id[nnEed above q[IAeATn//ATAnn.eg rof WG dn.I�.arNy Wel <br /> all ivrorinliev provided on Wla vppliunoe b we and eorren;ud Wdr aE reEpbeed acddrim MA be perrprBw!b uc9rdanee MiW an aPparable SAn JavQu¢i CormrY ONm.Codas vndlor <br /> Senlldafde end STATE Avdlor PmwAl.l.m Intl RePdaysu.Aa dx wderdgad ewnery gpervror,qr a fen loR.6e properly loobd al Iba above bci0ry/rite addras,l hceby aurM1orbe W e rdes N <br /> vrry ved JI.soba and emGoaneet[I sun[apl Mprvud9d W SAN IOAOUIN COUNTY r ERONMENTAL HEALTH DEPART u n u rvrbbk and ar tYe mw eua ie e <br /> pfavNN m ae or my reprtaenWive. <br /> APPLICANT NAME REwse Peva va;en <br /> C�z SIGNATURE <br /> TITLE (Jn/ 's ( PeAIRICE e <br /> � DRIVERS LI <br /> (pl101OfaI1'RE <br /> A,,W dBy _ RYIe 0 D -. Ar yBmtlep ORicA 0.o9ardna eo.f+ekd eY (] a o b <br /> 29024M 4r:115,I003 DeOe <br />