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-+-^'-06/10/2008 11:40 2094§al38 ENVIRONMENTA ALTH PAGE 02/03 <br /> °AtP run 6/1012008 11:33:32A1 SANWUIN COUNTYENVEA. Reportozo2s <br /> Run by 4006 IRONMENTAL HDEPARTM�MT <br /> D <br /> i 2tion as of 6/10/2008 Pag`' <br /> Record$aloctbn ty ID FA000181 <br /> �{ JUN 12 2008 Mak!Changeslcorroctions in RED ink or pencil. <br /> 1 II�ORMATION CHANGE(date) <br /> ENWO MENT HEALTH <br /> <br /> Owner ID OW0001421 New Owner ID <br /> Owner Name MEANS, L IE - <br /> Owner DBA 8ULLF G LANDING#MARINA LV, <br /> Owner Address 40 ACON PL <br /> COVERY BAY, CA 94505 i <br /> Home Phan 925-784-2329- <br /> Wark/Business P ne 209-465-9610 <br /> Mailing,Address pe-50X-"ft -72 <br /> W41RQN, CA 9454 4 Care of �7CC��j I QA 's�� <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001818 <br /> Facility Name BULLFROG LANDING♦MARINA1 Lt--C- <br /> Location 17251 B 6N ISLAND RD <br /> ST ON,CA 95219 <br /> Phone 9-465-9810 A <br /> Mailing Ad ss Pe 0 rX a-44j9- AC-0/J lSt O <br /> AD 9 <br /> Care of MEANS, LONNIE <br /> Location Code 99- UNINCORPORATED P AN Phone' <br /> BOS District 003-MOW,VICTOR Fax C:zU4 4 <br /> APN 12917003/7 EMail; <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contod Na �"� L �✓ r j�/C� <br /> Title <br /> Day Phone 2D9465-961 0 C; <br /> Night p4wlg�i- `- -- — <br /> ACCOUNTS RECEIVABLE FILE INFORMATION ` 3 — Z <br /> Account ID AR0001823 New Account ID: : <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name BULLFROG LANDING & MARINA (CtrdeOne) <br /> Account Balance as of 6/10/2008: $175.00 <br /> (Cuda one) <br /> Tranererto Adhra/rnsctve <br /> Program/Element and Description Recons ID Empwyeo ID and Nemo 51AtU$ New Ownr.R Delete <br /> 1615-RETAIL MKT 1,2000 SQ FT (PREPKGD/LTCPRO160902 EC0001699-JOHNNY YOAKUM Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511980 EE0000000-HAZ MAT SJC OES Inactive y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO521083 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPROW9692 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2836-AST FAC>/=100 M+1 GAL CUMULATIVE PR05167D4 EE0008317-RAYMOND VON FLUE Active Y N A 1 0 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1.the uderslgned owner,operaler or o9wo of same.,citrwmeage mo SII%6%and/or project Wedllc_pHWEMD aelrly charg"essodated wah ttaa <br /> rxlyty or activity wtg be billed to V*Party ide"04d as the OWNER on ors tornr. I also cwwy that ay opsmtons wls be pelft in accordance with mil appkubte Ordm*es Codas and/or Standem and <br /> $late and/or Federal Lewe. <br /> l <br /> �APPLICANTS SIGNATURE tip` � Date <br /> Program Records to be TRANSFERED; '$20.00= Amami 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: pate ! 1� <br /> COMMENTS: <br /> 1\phs-ehsgt-nttapps*nvisionskeports15021.rpt <br />