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E <br /> 1/10/2008 2:04:04Pk SAN JOAN COUNTY ENVIRONMENTAL HEALT EPARTMENT Report#5021 <br /> Pagei <br /> 4006 Facility Information as of 1/10/200ection Criteria: Facility ID FA0006852 <br /> Make changesicorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010694 New Owner ID <br /> Owner Name MILLER SPRINGS REMEDIATION MGT <br /> Owner DBA <br /> Owner Address 2480 FORTUNE DR STE 300 <br /> LEXINGTON, KY 40509 <br /> Home Phone 859-543-2100 <br /> Work/Business Phone Not Specified <br /> Mailing Address 2480 FORTUNE DR STE 300 <br /> LEXINGTON, KY 40509 <br /> Care of PRICE, KEN <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006852 <br /> Facility Name OCCIDENTAL CHEMICAL CORP <br /> Location 1904 W CHARTER WAY <br /> STOCKTON, CA 95205 <br /> Phone 209-472-2020 <br /> Mailing Address 2480 FORTUNE DR STE 300 <br /> LEXINGTON, KY 40509 <br /> Care of PRICE, KEN <br /> Location Code 01 -STOCKTON APN. <br /> BOIS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0009556 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name MILLER SPRINGS REMEDIATION MGT (Circle One) <br /> Account Balance as of 1/10/2008: $0.00 <br /> (Circle One) <br /> Transfer Omer Active inacive <br /> fete <br /> New OwneY7 Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2960-RWQCB SITE PRO505548 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> Stale 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: -*$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />