Laserfiche WebLink
Date run 10/11/2006 4:48:13F SAN JUIN COUNTY ENVIRONMENTAL HE4W DEPARTMENT Report#5021 <br /> Run by 4006 � Pagel <br /> Facility Information as of 10/11/2006 <br /> Record Selection Criteria: Facility ID FA0015024 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011025 New Owner ID <br /> Owner Name USA PETROLEUM CO <br /> Owner DBA USA PETROLEUM CO <br /> Owner Address 905 RANCHO CONEJO BLVD <br /> NEWBURY PARK, CA 913201716 <br /> Home Phone 805-214-9200 <br /> Work/Business Phone 805-214-0925 <br /> Mailing Address 905 RANCHO CONEJO BLVD <br /> NEWBURY PARK, CA 913201716 <br /> Care of ALONSO, OLIVIA <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0015024 <br /> Facility Name USA GASOLINE#3756 <br /> Location 13975 E HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Phone 209-727-3464 <br /> Mailing Address 13975 E HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> Location Code 99 - UNINCORPORATED AREA APN:01908014 <br /> BOS District 004 -SEIGLOCK, JACK SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025670 New Account ID: <br /> Mail Invoices to ACeDtffA Mail Invoices to: Owner / Facility I Account <br /> Account NameAL CO fVC (Circle One) <br /> Account Balance as of 10/11/2006: $0.00 <br /> (Circle One) <br /> TranswneR Delete <br /> fer to <br /> Active/Inactve <br /> NewOwner'? <br /> Program/Element and Description ecord ID \Employee ID and Name Status <br /> 2950-ENVIRON ASSESS �.PR0522eO57EE0000997-HARLIN KNOLL Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the ur or agent of same,acknowledge that all site,and/or project specific,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 and/or Standards and <br /> State and/or Federal Laws. n A <br /> APPLICANTS SIGNATURE: U�` i�a��� Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRAN FERED: $372.00= Amount Paid �'6ate 1121 // / O 6 <br /> Payment Type Check Number 2y D S Received by 2-1 <br /> REHS: Date / / Account out: Date_c/_ / 0/0 <br /> COMMENTS: <br /> PAYMEN.T. <br /> RECIE IVED <br /> OCT I 12006 <br /> SAN JOAOUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />