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Date run 4/16/2018 4:21:29Pfv SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/16/2018 <br /> Record Selection Criteria: Facility ID FA0024461 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0023026 New Owner ID <br /> Owner Name SAYBROOK CLSP LLC <br /> Owner DBA <br /> OwnerAddress 303 TWIN DOLPHIN DR 600 <br /> REDWOOD SHORES, CA 94065 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 303 TWIN DOLPHIN DR STE 600 <br /> REDWOOD SHORES, CA 94065 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0024451 <br /> Facility Name CENTRAL LATHROP SPECIFIC PLAN <br /> Location 783 SPARTAN WAY <br /> LATHROP, CA 95330 <br /> Phone 650-632-4522 <br /> Mailing Address 303 TWIN DOLPHIN DR STE 600 <br /> REDWOOD SHORES, CA 94065 �rnJA f I // l <br /> Care of v V �__v i- L, <br /> Location Code Alt Phone <br /> BOIS District Fax <br /> APN EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 650-6324522 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0045636 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SAYBROOK CLSP LLC (Circle One) <br /> Account Balance as of 4/16/2018: $0.00 <br /> (Circle One) <br /> Transferlo ActiveJlnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner' Delete <br /> 1920-HMBP-Common Materials PRO542527 EE0000009-NICHOLAS LOEHRER Active Y N A8 <br /> D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO542577 EE9999997-TWO VACANT2 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER an this form. I also certiry that all operations will be performed in accordance with all applicable Ordinance Codes and'or Standards and Stale and'or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received Ity <br /> EHD Staff: Date / / / Account out: Date <br /> COMMENTS: �r � / ��q /I� <br /> SLGt.IL lozooT C_a)zed a /l� 1(7000 j1�G �' `6L t-1L• IntG(-JLTAa"r <br /> -FA'K W`<< � eix��j unt/G t11e fa";jjty sIt( <br /> tGi 91✓z°yL �o the Cry Df^ Gat`h0 , - v5 v'e/L 5 A&5trt5 <br /> �L>o�o6d �o � �2"rcS�G• <br />