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Date tin 8/25/2003 2:37:35PA SAN JC IUIN COUNTY ENVIRONMENTAL HE? H DIEPARTMENT Report#5021 <br /> Run by <br /> �./ Facility Information as of 8/25/2003 Paget <br /> Record Selection Criteria: FacaTrty ID FA0014347 <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 0011397 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 209-47$-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 6425 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 /> A000unt ID AR0024377 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner I Facility I Account <br /> Account Name G EOT ► (Circle one) <br /> Account Balance as of 81251200 : <br /> (Circl <br /> Transfer to Activ nactve <br /> ProgramlElemenlond Description Record ID Employee ID and Name Status Now Owner? Delete <br /> 2950-ENVIRON ASSESS PR0519189 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,PHSfEHD 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 an operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: "$20.00= Amount Paid Date 1 1 <br /> Water System to RAN FRED: `$155.00= Amount Paid Date 1 I <br /> Payment Typ Check Number Received by ,. <br /> RENS: Date /Z"51 O Account out: Date I 1 I f <br /> COMMENTS: <br /> oe <br /> 11Phs-ehsql-ntlapps\Envisions%Reports15021.rpt <br />