Laserfiche WebLink
u <br /> Q.%e run 7/24/00 10:08:30AM SAN*QUIN COUNTY PUBLIC HEALTH SERWS Report #: 0002 <br /> Run by VDAVIS Facility Information as of 7/24/00 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0004532 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID; OW0003440 New Owner ID <br /> Owner Name: KEARNEY NATIONAL INC <br /> owner DBA; KEARNEY NATIONAL INC <br /> Owner Address; SIaS Yr,6 II-✓E 4- 4 L <br /> 4 3gg5— N EW 4044- N Y 1,00(7 —iFf <br /> Home Phone: Not Specified <br /> work/Bussness Phone: 914-694-6701 �/ <br /> Mailing Address; 5&,5' Q:� ' `"E rL `(( <br /> rL <br /> WHIT-E-P60,1049, NY 10694 2 1JEU YJRK. ti� loop-zy2 <br /> Care of KEARNEY NATIONAL INC <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0004532 <br /> Facility Name: KEARNEY NATIONAL(FORM.KEARNEY KP <br /> Location; 1624 E ALPINE AVE <br /> STOCKTON, CA 95205 <br /> Phone; 209464-8381 <br /> Mailing Address: <br /> v ALI foot—r --W <br /> Care of: <br /> Location Code: 99 - UNINCORPORATED AREA APN; 117-080-06-09 <br /> BOS District: 002 -MARENCO, DARIO SIC code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0004273 New Account ID:; <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility I Account <br /> Account Name: KEARNEY NATIONAL(FORM.KEARNEY KPF) (Circle One) <br /> Account Balance as of 7/24/00: $78.00 <br /> (Circle One) <br /> UST(s) Transferto Active/Inecty <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PR0009012 EE0000997-KNOLL Active Y N I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT.• 1,the undersigned owner,operator or agent?I-same,acknowledge that all site,and/orpro ect <br /> specific,PNSIEND hourly charges associated with this facihry or activity will be billed to theparty idents red as the BILLING PARTY on thisform. I <br /> also certiifythat ahoperations will beperformed inaccordance with all applicable OrdinaceCodes an or Standards and State and/orFederal Laws <br /> APPLICANT'S SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: "$150.00= Amount Paid Date 2(_L— <br /> Payment <br /> /Payment Type Check Number Receipt Number Received by <br /> REHS: Date_/_/_ Account out: Date 1 / ZS / D D "DA7Ob <br /> /hFFlt Nr�J j✓olc� 1/2-1lei <br /> 1.0.0.89.00 <br />