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Date me 4/16/2018 4:21:29PN 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 FA0024451 <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 A/1 <br /> Care of AVL-oL t V lv /X <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 650-632-4522 <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 /> (Circe One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0542527 a EE0000009-NICHOLAS LOEHRER Active Y N AB D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0542577 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,ander project speck,PHSEHD hourly charges associated with this facility <br /> or activ'M1y will be billetl to the party identified as the OWNER on this forth. I also certily that alt operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws. <br /> APPLICANTS 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 y <br /> EHD Staff: e Date / / Account out: Date <br /> COMMENTS: Invoice#: <br /> S i2 lbl�� C©UG�� G1 /ice ),Xe �12<L t/ie <br /> fare <br /> I Gi l✓�°l2 `�0 t`i� C� � G�tk6�. � r�5 �JeR ut6L5f� <br /> 9 �t��o4d -FO �)e je�&14 <br />