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Date run' 2/13/2014 11:48:57AI SAN JC UIN COUNTY ENVIRONMENTAL HEA' I DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/13/2014 <br /> Record Selection Criteria: Facility ID FA0004175 <br /> Make inRED ink. <br /> INFORMATION CHANGE(dam) <br /> OWNERSHIP CHANGE(daue) <br /> OWNER FILE INFORMATION 8Gw/Fed Tax|o � <br /> Owner ID (]VV0001047 New Owner|o � <br /> Owner Name T|K| LAGUNPARTNERS LLC <br /> Owner DBA T|K| LAGUNRESORT & MARINA <br /> Owner Address 0243EMBARCADERO OR <br /> 8TDCKTON. CA0521Q <br /> Home Phone 209'601-4538 <br /> VVodo8uvinosophone 209-484'2980 <br /> Mailing Address 6243-EM8AR{ABERO-DR- acf 1—S |e <br /> ST0,13-h3'DN-(�\-Q5319 ��n� <br /> . <br /> ' <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility|o/cEna|o FA0004175 10.181.603 <br /> Facility Name T|K| LA8UN RESORT & MARINA <br /> Location 12988VVMCOONALORO <br /> STOCKTDN, CA 95206 <br /> Phone 209-464-2880 <br /> Mailing Address 36-20-VVHAfNK4ER-LN-SUITEO- <br /> S-TOCNT-QNrCA--9521S <br /> Care of T|K| LAGUN PARTNERS LLC <br /> Location Code QQ ' UNINCORPORATED A Alt Phone <br /> aosoismct 003 ' BE8TOLAR|DES Fax <br /> APN 13103026 Email: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name FAX#(415)456'5250 <br /> Tido <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004255 New Account ID: � <br /> Mail Invoices to Facility Mail Invoices to: owner / Facility / Account <br /> Account Name Tl0 LA8UN RESORT &MARINA (Circle One) <br /> Account Balance aanf2/13/2O14: $1.238.00 <br /> (Circle One) <br /> Transfer* am~"/"acm° <br /> Program/Element and Description' Record ID Employee mand Name o*m" New Owner? o°/"* <br /> 1610 nsTx|LMARKET< 1oUoGQrTxv/FOOD PREP Pno100e28 EE0001420 msuSS*N|8S|M Active Y w A | o <br /> 1nz1 'HMBP'Renu|ar-PhmaryLocation PR0519572 sEonnD7O8'JAMIE osL*nOSA Active v N A | o <br /> zuun-smHvvoEw^oTowa/Yn Pnoozn000 ss0001421 aTAcYnmsn* Active Y w * | o <br /> 222* H8zMAT BUSINESS PLAN AUTHORIZATION PR001842 ssOnoOoOo'n*ZMAT SJCOE3 |nactiv( v N * | D <br /> 23e1 UST FACILITY(BEFORE 1/o4)'obsolete PR0231679 ssonoo418'MICHAEL KITH |naotiv( Y N A | D <br /> 2399 UNIFIED PROGRAM FAC STATE SURCHARGE p PnU508354 sE0007289'AL|GONYOUNGoLOOO |nootiv( Y N A | o <br /> 2832'8GTFAC 1OK-</=1OOKGAL CUMULATIVE PR0516680 EE0001421 '8TAoYRmsnA Active v N A | o <br /> 47+0 WASTE TIRE SITE EXEMPT PR0523808 Es5555555 Go,moA|ias'Bankus |nomivE Y w A | D <br /> snSC'ELECTRONIC REPORTING STATE SURCHARG PR0531038 |noCtiv, Y N A | o <br /> ^Onn'TNCWATER SYSTEM vvA0460583 EEoOOo838-ADRIENNE ELLSAEGSsn Active Y m x | D <br />