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DSM 7/7/2008 3:38:37PM SAP )AQU1N COUNTY ENVIRONMENTAL I LTH DEPARTMENT Report#55021 <br /> Run by .Awl V Pagel <br /> Facility Information as of 7/7/2008 <br /> Recad selxnnn cdtene: Faday ID FA0003155 <br /> Make changeWcorrectlons in RED Ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002353 New Owner ID <br /> Owner Name FLOWERS, KORINNE <br /> Owner DBA <br /> Owner Address 5117 MONTALBANO CT <br /> SALIDA, CA 953689339 <br /> Home Phone 209-835-3182 <br /> Work/Business Phone Not Specified <br /> Mailing Address 5117 MONTALBANO CT <br /> SALIDA, CA 953689339 <br /> Care of FLOWERS, KORINNE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003155 <br /> Facility Name THE OASIS MARINA-RESORT <br /> Location 12450 W GRIMES RD <br /> TRACY, CA 95304 <br /> Phone 209-835-3182 x0 <br /> Mailing Address 12450 W GRIMES RD <br /> TRACY, CA 95304 <br /> Care of TRACY OASIS MARINA <br /> Location Cade 99-UNINCORPORATED A AN Phone <br /> BOS District 003- MOW, VICTOR Fax <br /> APN 18912020 EMall: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name KORINNE FLOWERS <br /> Title <br /> Day Phone 209-835-3182 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002720 New Account to: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name THE OASIS MARINA-RESORT (cede oro) <br /> Account Balance as of 7/7/2008: $0.00 <br /> Icirw ann <br /> Transfer to Adivrinadye <br /> ProgyuEbmwtl and Dseclp an Record ID Employee ID and Name slow New Owner? Dale* <br /> 1615-RETAIL MKT<2000 SO FT (PREPKGD/LTOPRO161213 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511593 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0519532 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0509305 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 83 AST FAC>/=100 M+ 1 GAL CUMULATIVE PR0516731 EE0000001 -LINDA TURKATTE Inactive Y N A 1 D <br /> 4 4-T NC WATER SYSTEM(ORTLY) WA0460998 EE0005838-ADRIENNE ELLSAESSEActive Y N A I D <br /> BILLING Bold COMPLIANCE ACKNOWLEDGEMENT: I,eu uderaigrned owner,operator ar aged d same,arknowledga Mat a1 ate,ara/r poled sperdlo,PHS/EHD hoary dnarges aesoruled Wtlll this <br /> IarJly ar ad C aA M besed b er party Idenafied as <br /> d_OWNER on tlu(arm. 1 oho certaY tlnr aY operatbns wW Ds padarmW in a=ordere With al apperable Ordlneca Codas WWW StarnOerdt OW <br /> s2�0�Le . <br /> APPLICANTS 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 Recety <br /> REHS: Date / / Account out: Date <br /> CO&SIENTS: <br /> 11phs-ehsgl-nt\apps\envisions\repons15021.rpt <br />