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- Run by : STAFF SAN 7UNTY PUBLIC HEALTH SERVICES <br /> Report ##5021 FRCP Y INFORMATION as of 08/0:'- 4 <br /> Make chanoes/corrections in RED Den or pencil: <br /> OWNER FILE INFORMATION Date of INFORMATION CHANGE: <br /> Date of OWNERSHIP CHANGE: <br /> OWNER ID: 002993 New Owner ID: 00_ <br /> Owner Name: PACIFIC GUANO CO ,__—_____ ..... . .. ...... _ <br /> Owner DBA: PURE GRO/BRER -------.--_._.__—_ <br /> Owner Address: PO BOX 7600 <br /> NEW PORT BEACH, CA 92664 <br /> Home Phone: 209-547-2650 —_— <br /> Work/Business Phone: 510-277-234II __ —_.-.._....__... <br /> Mailing Address: 1276 HOLYARD DR _-- —.- ____,__..__.__.._- <br /> Care of: PURE GRO CO <br /> WEST SACRAMENTO, CA 95691 <br /> FACILITY FILE INFORMATION — <br /> FACILITY ID: 004074 <br /> Facility Name: PURE GRO/BRER <br /> Location: 1905 N BROADWAY <br /> S'TOCKTON 95201 <br /> Phone: 209-547-2650 ��j C <br /> Mailing Address: 1336 W FREMO ST C/ �. G .R, r --- ----- <br /> Care of: PURE GRO/ A—KURT NEUHARTH Gf/. T Alfe 6E"0n/ <br /> STOC CA 95203 2,000 UOW 0*Vy 661 <br /> _ foo _ <br /> Location Code: 01 APN: 2 I (9A- fX_1 <br /> BOS District: 01 SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0003734 New Account ID: 000___ <br /> Mail Invoices to: Reremrnt� � Mail Invoices to: Owner / aci l ity <br /> Account Name: <br /> Account Balance as of 08/03/94 : $ 124. 80 <br /> FILES LINKED: No WATER SYSTEM FILE linked <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> 2960 RWOCB CLEAN UP SITE PR869161 8684 INFURNA ACTIVE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersioned owner, operator or anent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN ;OA[N1SN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date—, _/ f9 <br /> Programs to be TRANSFERED: —._--....._ x 528.00 . ..__--Amount Paid „„ ---------__-,— Date _-- / _/9 <br /> Payment Type ..— ---.--.__ _._ Check 1! __....._..... Recvd by <br /> -------------- -- ----- — p---------------------------c— <br /> REHS or COUNTER SUP U: __--^ Date.,_. /,. _/9 ACCT out:__-_,_ Date,- 0 //57/9 __57/9 UNIT/File: /_____._/ 3 <br />