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Date run 9/23/2003 3:12:02PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 9/23/2003 Pagel <br /> Record Selection Criteria: Facility ID FA0014865 <br /> Make changeslcorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0011871 New Owner ID <br /> Owner Name CALIFORNIA NATURAL PRODUCTS <br /> Owner DBA CALIFORNIA NATURAL PRODUCTS <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1250 E LATHROP RD <br /> LATHROP, CA 95330 <br /> Care of LYNN FORCUM <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014865 <br /> Facility Name CALIFORNIA NATURAL PRODUCTS <br /> Location 1250 E LATHROP RD <br /> LATHROP, CA 95330 <br /> Phone <br /> Mailing Address 1250 E LATHROP RD <br /> LATHROP, CA 95330 <br /> Care of LYNN FORCUM <br /> Location Code APN: <br /> SOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025389 ¢ 0 tk ✓� , j'3 New Account ID: <br /> Mail Invoices to Facility Mdil Invoices to: Owner / Facility 1 Account <br /> Account Name CALIF NIA NATURAL RODUCTS (ClrcleOne� <br /> Account Balance as of 9123120 $-8.00 , <br /> (Circle One} <br /> Transfer to Active/inactve <br /> Program/Element and Description __/ record iD Employee ED and Name Status New Owner? Detete <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PRO521881 EE0000942-MARGARET LAGORIO Active Y N A I D <br /> 81LING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity witl 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 andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: "$20.00= Amount Paid Date I ! <br /> Water System to be TRAANSFERED: "$155.00= Amount Paid Date 11 e 3 <br /> Payment Type V Check Number ilo'q- �` Received by <br /> REHS: T /r`` Date ! ! Account out: Date I 1 <br /> COMMENTS: <br /> ttPhs-ehsgl-ntlappslEnvisionslReports15021.rpt <br />