Laserfiche WebLink
04/29/2005 09:27 CLAYTON GROUP 4 12094683433 <br /> N0.319 D02 <br /> i San Joaquin County Environmental Health L,-paetment GREEN FORM <br /> DATE 29f MASTER FILE RECORD INFORMATION "MEAT" UNIT IV <br /> awn ,[r nau OwnER ID# eiD(30P "As" <br /> OWNER FILE Lwee,Trr OWNER Cuace7YnvmffLfwtrw END <br /> canlrltr MA.F;a+-owjN&PROPS OWNS mF ATION'' 010M Z — S <br /> PROPUM ommot NAME t v1 <br /> Fe9 <br /> MI L95I <br /> sa srr/TAxxo# <br /> C{ISIM¢SS NAwr <br /> 1 DRIveKs Lrr#11Off# <br /> OwnerFkTm Address �o N- a _. .+� <br /> ,}- GTAIe <br /> A <br /> city �. <br /> Mmm KaANd Addraea <br /> zip SZc-77- <br /> Madinil Address CRY ,S .Q C <br /> { "V <br /> PARTNPRSMIPPM=Mcr❑ GT ER <br /> coaroRAnon❑ intnvlp�Q (r <br /> FACILITY FILE <br /> .. OSSRrrID# ACTAUNTID# �b'' 9 �% IWIt iN <br /> GR <br /> FAaUTTIDA ' �I �.,5 to <br /> Y�s NO <br /> t5 this a"RW Baslltew LOGTIun not previcustY regulatdQ hV the EI/YIROMMErITAL HEALTH DEPARTMENTt vFe No <br /> Is thIs an EM6,11 A"dilness I?M OM but a NEW TYPE of r ulatrd BuslneasT <br /> BinTltgG JPAOLrrTJSile Nano auslness PrtoNE <br /> Sm AopPM 3z) 3 W s-r (A-0 L n r"' <br /> crn ���L��U <br /> KM <br /> guARC OP SUPER1EsgR DISTRIOT <br /> LocATtoN Coce Ker1 <br /> AboMben:dr Care Df(003"Q <br /> man he Address WADI iN2'rYam PucarlyAdI <br /> STA" pP <br /> MRGing padres QtY p <br /> SIC Coce -y <br /> APN# if !6 l (�9-- CawMeNn (j t-�F�' <br /> Owner orFacility OPerdtar Jden6hedabove. <br /> THIRD FARn�uwNn INFO; Complete if 6111ine Party Is different from PrDPelty Aao dlon:wwrE m (aa� r <br /> Madleq padt� deo <br /> STAR <br /> c»r ear 17 <br /> farfeesand chargos OWNER <br /> FAC{L"1BUSINEss IAD PAIm BA.UHG . <br /> I,Mc anAtnlen[d APPI{nnt ccnly shot I a.,rha O,.wn,UP'°'^n",or AarAa til AgeN vftNc Dudr.rn.and I&=For thO it, all w oea1"y that <br /> yp�,,0"yam p>tggt�lffilfCfLIRC23 vnA+nr HOVRLI'C/UACbs paeuaialed with this operaGun will to billed to me niche address idmlifiad 111 Opus W[A�or"�'annaras For O eha I a4v mas and/a, <br /> a enloflas .pert,lomtcd at to..'Wc fadRry/alt[addKer,I he v.nheak[dm Kka+e of <br /> e11 hdvrrmdvn provided op lUU vpPllwdnn k aee and rorrayq and ib4t.all Kguulal anivldrs wal by pn�nnod In vauW-11co wills pII opplkablc SAN JOAQII[N Co11NIT QrWa° Codas an or <br /> I,OW ,de.kl GTAne aed+ar Vuorr N.LOW and neg4loUone. An the OvAeo"h td WAC,opCamr,or 6 IR <br /> Or,aW a0 rww"and rnNronmenral awaemm t Inrarmnuon m&cN SOAOL7N COUNTY]ENVM0.r1 ENTAL IiFALT1r 11aTAItx'MEN7 Al vop aUk and a the wlc 4M <br /> provxw a me or mY MPnew(IIIIIIII c glrlTr SIGNATURE <br /> App"rANT TI <br /> ` DI LICENSE# <br /> TITLE ®�✓C� f —� (vMoraoPr RcoutacRl <br /> rr�v <br /> rj <br /> Appevwd BY Deu <br /> AcmM.0-0 Mea pmrardna minpleted BY Data <br /> 29-02.005 April 25,2003 <br />