Laserfiche WebLink
Date run 10/19/01 11:46:29AM $ %QUIN COUNTY FLIBLIC HEALTH S� Page #:ES Report #: 6023 <br /> Run by 1 <br /> Facility Information as of 10/19/01 <br /> Record Selection Criteria: Facility ID FA0006852 <br /> Make changes/corrections 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 WY <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: 163-020-17/29 <br /> BOB District: 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0009556 New Account ID: <br /> Mail Invoices to: Account Maillnvoicesto: Owner/Facility/Account <br /> Account Name: MILLER SPRINGS REMEDIATION MGT (Circle One) <br /> Account Balance as of 10/19/01: $43.50 <br /> (Circle One) <br /> Transferto Active/lnacive <br /> Program/Elementantl Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWOCS CLEAN UP SITE PR0505548 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 specific,PHS/EHO hourlycharges 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 /> State and/or Federal Laws. <br /> 4PPLICANT'S SIGNATURE: Date / ! <br /> 'rogram Records to be TRANSFERED: "$20.00= Amount Paid Date <br /> Nater System to be TRANSFERED: *$150.00= Amount Paid Date <br /> layment Type Check Number Received by <br /> REHS: Date_/ / Account out: Date <br /> ;OMMENTS: - <br /> Phs-ehsq I-nt\apps\Envisions\Reports\5021.rpt <br />