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Date run 6/30/2004 9:08:20AA SAN,IO, )IN COUNTY ENVIRONMENTAL HEAI\J DEPARTMENT <br /> Run by PagelRup�Q#5021 <br /> Facility Information as of 6/30/2004 Page' <br /> Record Selection Criteria: Facility ID FA0014617 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE,(date) _ <br /> OWNERSHIP CHANGC(date) <br /> OWNER FILE INFORMATION �. . <br /> Owner ID OW0011633 New Owner ID -IN4Z <br /> Owner Name F&W CATTLE CO <br /> Owner DBA <br /> Owner Address 782 CAMINO CT <br /> MANTECA, CA 95336 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 782 CAMINO CT <br /> MANTECA, CA 95336 <br /> Care of F&W CATTLE CO <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014617 <br /> Facility Name F&W CATTLE CO <br /> Location 782 CAMINO CT <br /> MANTECA, CA 95336 <br /> Phone <br /> Mailing Address 782 CAMINO CT <br /> MANTECA, CA 95336 <br /> Care of F&W CATTLE CO <br /> Location Code APN:21735014 <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024864 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name F &W CATTLE CO (Circle One) <br /> Account Balance as of 6/30/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Mactve <br /> Program/Element and Descri hon Record l0 Employes, New Owner? Delete <br /> p� p yea ID and Name Status <br /> 2217-APPLIANCE RECYCLER PR0521528 EE0008389-DENNIS CATANYAG Active Y N AlO D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all she,and/or project specific,PHS/EHD hourly charges associated with the <br /> facility or activity will be billed to the parry,identified as die OWNER on this form. I also certify Nat all operations will be performed in accordance with all applicable Ordinace Codes ant/or Standards ant <br /> State and/or Federal Laws, <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: .$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: fly" Date Oen /fig_/os� Account out: Date <br /> COMMENTS: <br /> \\Phschsgl-ntW pps\Envisions\Reports\5021.rpt <br />