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Date run 8/16/01 9:26:13AM Si 'OAQUIN COUNTY PUBLIC HEALTH S (ICES Report #: 5023 <br /> Run by Facility Information as of 8/16/01 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0001340 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0001045 New Owner ID <br /> Owner Name: HANNON, DARRYL <br /> Owner DBA: TURNER CUT RESORT <br /> Owner Address: 12888 W NEUGEBAUER RD <br /> STOCKTON, CA 95206 <br /> Home Phone: 209-465-4129 <br /> Work/Business Phone: 209-946-9409 <br /> Mailing Address: PO BOX 1281 <br /> SANTA CRUZ, CA 95061 <br /> Care of: DARRYL HANNON <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0001340 <br /> Facility Name: TURNER CUT RESORT <br /> Location: 12888 W NEUGEBAUER RD <br /> STOCKTON, CA 95206 <br /> Phone: 209-946-9409 <br /> Mailing Address: PO BOX 1281 <br /> SANTA CRUZ, CA 95061 <br /> Care of: DARRYL HANNON <br /> Location Code: 99 - UNINCORPORATED AREA APN: 131-020-16 <br /> BOS District: 003 - MOW, VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0001338 New Account ID: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: TURNER CUT RESORT (Circle One) <br /> Account Balance as of 8/16/01: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1624-RESTAURANT/BAR 21-50 SEATS PRO160788 EE0003497-RACHEL QUINLIN Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511648 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PR0516783 EE0000008-LETITIA BRIGGS Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE F PRO509360 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 4633-TNC WATER SYSTEM WA0460759 EE0000149-RAYMOND BORGES Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the 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 and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />