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gate run ,/200612006 1:59:10PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021Run by 4 Pagel <br /> Facility Information as of 3/21/2006 <br /> Record Selection Criteria: Facility ID FA0006798 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0005584 New Owner ID <br /> Owner Name SOUZA, �R.�-� <br /> Owner DBA l C6 E- /U <br /> Owner Address T 3 <br /> TRS -95376 <br /> Home Phone 209-835=-8330 <br /> Work/Business Phone Not Specified <br /> Mailing Address 105 E 10TH ST <br /> TRACY, CA 95376 <br /> Care of AN <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006798 <br /> Facility Name -Sf)6LZA P-R-GPERTY �„t¢t.� <br /> Location (/ <br /> To�T,C. 95376- <br /> Phone 2�r< �5833� �jZ�� FETE/R� <br /> Mailing Address 105 E 10TH ST / 5 3 <br /> TRACY, CA 95376 <br /> Care of Af444ONY APN:238-080-0 O$ <br /> Location Code 99--UNINC-ORPORA�AREt�T1�uf <br /> BOS District 005-ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0009397 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name STANDARD PACIFIC OF NO CALIF (Circle One) <br /> Account Balance as of 3/21/2006: $0.00n/` 1/ERQ,v�c� / Ey <br /> Q (Circle One) <br /> 9Z15. V . F7760 Transfer to Active/Inactve <br /> 7 New Owner? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2950-ENVIRON ASSESS PR0505477 EE0000684-MICHAEL INFURNA Inactive ACri v'e 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 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 <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date 3 / / <br /> Payment Type Check Number Lf —1'7 4 Received by <br /> REHS: Date / Z� / O� Account out: Date <br /> COMMENTS: <br /> 14790 q <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />