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Date run 9/23/2003 3:12:02Ph SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/23/2003 <br /> Record Selection Criteria: Facility ID FA0014865 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <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 /> BOB District _ , $1\I / SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION �Ait II+JV��G /�� <br /> Account ID AR0025389 O ^/I New Account ID: <br /> Mail Invoices to Facility ,� / it Invoices to: Owner / Facility / Account <br /> Account Name CALIF NIA NA URAL RODUCTS (Circle One) <br /> Account Balance as of 9/23/20 <br /> (Circle One) <br /> Transfer to Activelractve <br /> Program/Element and Description Retord ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0521881 EE0000942-MARGARET LAGORIO 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 speck,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 andlor Standards and <br /> Stale and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date ! '2 / <br /> Water System to be TRANSFERED: '$155.00- Amount Paid 20I Date 03 <br /> Payment Type Check Number Q'Ii rl -4 7.- Received by <br /> REHS: yl.` Date / / Account out: Date_/ / <br /> COMMENTS: <br /> V-LGan�ee- CA AJAAt u pftv�,+e-rs <br /> AWL,,( � IA9 ($,f3� k)--, �.�-�a��� Csr��) to <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt 41 <br />