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Date run 11/26/01 11:26:10AM SA*AQUIN COUNTY PUBLIC HEALTH SEES Report u: 5023 <br /> Run by Facility Information as of 11/26/01 Page u. 1 <br /> Record Selection Criteria: Facility ID FA0004090 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW 0000857 New Owner ID <br /> Owner Name: DIAMOND OF CALIFORNIA <br /> Owner DBA: DIAMOND OF CALIFORNIA <br /> Owner Address: 1050 DIAMOND ST <br /> STOCKTON, CA 95205 <br /> Home Phone: Not Specified <br /> Work/Business Phone: Not Specified <br /> Mailing Address: PO BOX 1727 <br /> STOCKTON, CA 95201 <br /> Care of: ACCOUNTING <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0004090 <br /> Facility Name: DIAMOND WALNUT GROWERS INC <br /> Location: 1050 DIAMOND ST <br /> STOCKTON, CA 95205 <br /> Phone: 209-467-6000 <br /> Mailing Address: PO BOX 1727 <br /> STOCKTON, CA 95201 <br /> Care of: DIAMOND WALNUT GRWS/M.LESCISIN <br /> Location Code: 01 - STOCKTON APN: 155 320 19 5 <br /> BOS District: SIC Cade: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0003750 New Account ID: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: DIAMOND WALNUT GROWERS INC (Circle One) <br /> Account Balance as of 11/26/01: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> -2 6TCRra PR0001781 Active Y N A I D <br /> agl/16 - 01)&C--P> OOD 11g7 '50—s"L&Ua— <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project speck,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this farm. 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: —*$150.00= Amount Paid Date / I <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date , //7 <br /> COMMENTS: <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />