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Daterun . :/18/2008 11:50:04AI SAN JO`UIN COUNTY ENVIRONMENTAL HEAkwiii DEPARTMENT Report#5021 <br /> Run M Pagel <br /> Facility Information as of 7!18/2008 <br /> Record <br /> /Selection Criteria: Facility ID FA00166�9-t5� <br /> E S / f Make changes/corrections in RED ink or pencil. <br /> / v INFORMATION CHANGE (date) <br /> -'4 OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013 New Owner ID <br /> Owner Name <br /> Owner DBA BARYE EGRET, I%NN j s <br /> Owner Address 244-HANIlliffS-En `. <br /> RIPON, CA 32 <br /> 953662 iLG <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address�[hJ <br /> Care of <br /> FACILITY FILE INFORMATION / <br /> FacilityID FA0016695 <br /> Facility Name ♦ E-r firyS r <br /> Location 2033 FRENCH CAMP RD <br /> MANTEL-amCA 9r�36 u 9j <br /> Phone <br /> Mailing Address <br /> G y <br /> Care of RIPQN, GA-955662,M <br /> Location Code Alt Pho e <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone i <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> i <br /> Account ID AR0029577 New Account ID: <br /> Mail Invoices to Owner i L / Y Mail Invoices I Owner I Facility / Account <br /> Account Name @REQ ®{ (Circle One) <br /> Account Balance as of 7/18/2OQ8: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> ProgramlElemenl and Descdpdon j Record ID Employee ID and NamaStatus New Owner'? Delete <br /> 2223-AGRICULTURAL HAZV'T 'MAT STORAGE FACILPR0524880 Active Y N A I D <br /> LIN a.d COMPLIANCE AC WLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor project specific.PHS/EHD hourly charges associated with this <br /> fad*or activity we be deed to party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards am <br /> State a dior Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS'. F IAIA&V�� ,;-/�/' <br /> Q-9-" f on LS <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />