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Date run : 3/9/00 3:35:12PM SAN' 1QUIN COUNTY PUBLIC HEALTH SER'_ ES Report #: 0002 <br /> Run by AYOUNGBLOOD Facility Information as of 3/9/00 Page #: 1 <br /> Record Selection Criteria: FacilityID FA0005324 <br /> Record ID <br /> Make changes/corrections k or pence.- <br /> INFORMATION CHANGE (date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE (date) <br /> Owner ID: OW0006512 New Owner ID <br /> Owner Name: ISE LABS <br /> Owner DBA <br /> Owner Address: 400 INDUSTRIAL DR <br /> MANTECA, CA 95337- <br /> Home Phone: 209-825-8314 <br /> Work/Bussness Phone: Not Specified <br /> Mailing Address: 400 INDUSTRIAL DR <br /> MANTECA, CA 95337- <br /> care of: GARY HUBBLE <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0006324 <br /> Facility Name: ISE LABS INC <br /> Location: 400 INDUSTRIAL PARK DR <br /> MANTECA, CA 95336 <br /> Phone: 209-825-8239 <br /> Mailing Address: 400 INDUSTRIAL PARK DR <br /> MANTECA, CA 95337- <br /> Care of: GARY HUBBLE <br /> Location Code: 04 - MANTECA APN: <br /> BOB District: 005-CABRAL, ROBERT sec code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0005786 New Account ID: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: ISE LABS INC (Circle One) <br /> Account Balance as of 3/9/00: $0.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inacty <br /> ro aMElement and Description Record ID Employee ID and Name Status Linked New Owner? Delete PR92200;18 1-2=07289 <br /> 2335-FARM UST#3 FACILITY PRO502089 EE0007289-YOUNGBLOOD Inactive 2 Y N I <br /> 2231 -HAZARDOUS WASTE PBR FACILITY PRO507158 EE0007289-YOUNGBLOOD Active Y N I <br /> 2211 -HAZ WASTE PBR FAC STATE SERVICE FEE PRO507159 EE0007289-YOUNGBLOOD Inactive Y N I <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE F PRO507160 EE0007289-YOUNGBLOOD Active Y N I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT.. I,the undersigned owner,operator or agent of same,acknowledge that all she,and/orprojed <br /> spedfh5 PHS/BMD hourly charges associated with this faciBty or activity will be billed to the party identyled as the BILLING PARTY on this form I <br /> also certify that all operations wig be performed in accordance with all applicable Or&nace Codes andlorStandards and State and/or Federal Laws <br /> APPLICANTS 31ONATURE: Date <br /> Program Records to be TRANSFERED: "$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: •$150.00= Amount Paid Date_/ I <br /> Payment Type Check Number Receipt Number Received by <br /> HS: Date/ co Account out: Date 03 <br /> R�,✓vl ove aa�� aft add.. aayo RC,� S ma,P,l hat cuciste �,vlp�tcu-Dr <5-rprisp (�.r <br /> 1.0.0.69.00 <br />