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Date run 9/4/2002 11:30:32AM SAN JOIN COUNTY ENVIRONMENTAL HEAiEPARTMENT <br /> Run by Report iR5a21 <br /> Facility Information as of 9/4/200 Pagel <br /> Record Selection Criteria: Facility 0 FA0004074 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0002993 New Owner ID <br /> Owner Name PACIFIC GUANO CO <br /> Owner DBA <br /> Owner Address PO BOX 7600 <br /> NEW PORT BEACH, CA 92664 <br /> Home Phone 209-547-2650 <br /> Work/Business Phone 510-277-2348 <br /> Mailing Address 1276 HOLYARD DR <br /> WEST SACRAMENTO, CA 95691 <br /> Care of PURE GRID CO <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004074 <br /> Facility Name PUREGRO/BREA <br /> Location 1905 N BROADWAY AVE <br /> STOCKTON, CA 95201 <br /> Phone 209-547-2650 <br /> Mailing Address 1336 W FREMONT ST <br /> STOCKTON, CA 95203 <br /> Care of PURE GRO/BREA-KURT NEUHARTH <br /> Location Code 99- UNINCORPORATED AREA APN: <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003734 <br /> New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name UNOCAL-C.E.R.T (circle One) <br /> Account Balance as of 9/4/2002: $0.00 <br /> Program/Element and Transferto (Circle One)Active/InacNe Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PR0009161 EE0000684-MICHAEL INFURNA Active Y N AD <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the u ersignetl owner, rater or agent of same,acknomedge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility Or activity will be billed to the party Identified as the OWN on this I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S 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 Reoeiv <br /> REHS: Date / Account out: Date_�/�/ O� <br /> COMMENTS: ~ <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt `%�� �./ //I!! • ' <br />