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Date run 11!412003 11:14:59AI SAN J JIN COUNTY ENVIRONMENTAL HEA O DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/4/2003 <br /> Record Selection Criteria: Facility ID FA0014347 <br /> Make changeslcorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011397 New Owner ID <br /> Owner Name LINCOLN PROPERTIES LTD <br /> Owner DBA LINCOLN PROPERTIES LTD <br /> Owner Address 374 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Home Phone 209-478-9200 <br /> Work/Business Phone Not Specified <br /> Mailing Address 374 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Care of BILL JOHNSON <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014347 <br /> Facility Name CURRENTLY VACANT <br /> Location 5425 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone 209-478-9200 <br /> Mailing Address 374 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Care of BILL JOHNSON <br /> Location Code 01 - STOCKTON APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024377 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner I Facility / Account <br /> Account Name GEOT S4NC (circle one) <br /> Account Balance as of 111412003: <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0519189 EE0000684-MICHAEL INFURNA Ac' e Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner.operator or agent or same,acknowledge that all site,an or project specific,PHS/END 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 Ordinate 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 1 I <br /> Water System to be T N ERED: '$155.00= Amount Paid Date 1 / <br /> Payment Type Check Number RQceivUby <br /> RENS: Date 1 1 Account out: ate1 !fL3 <br /> COMMENTS: <br /> 11Phs-ehsql-ntlappslEnvisionslReports15021.rpt <br />