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Report#5021 <br /> ERecord <br /> 7/26/2004 9:51:31 AN SAN J UIN COUNTY ENVIRONMENTAL HE DEPARTMENT Repel <br /> Facility Information as of 7/26/2 u4 <br /> Selection Criteria: Facility ID FA0014704 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011715 New Owner ID <br /> Owner Name RODNEY R SCHATZ <br /> Owner DBA MOKELUMNE RIM VINEYARDS <br /> Owner Address 18247 N TRETHEWAY RD <br /> LOCKEFORD, CA 95237 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-367-4881 <br /> Mailing Address 18247 N TRETHEWAY RD <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014704 <br /> Facility Name MOKELUMNE RIM VINEYARDS <br /> Location 22150 N KENNEFICK RD <br /> ACAMPO, CA 95220 <br /> Phone 209-365-9634 <br /> Mailing Address 18247 N TRETHEWAY RD <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> Location Code APN: <br /> BOS District SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025011 New Account ID: <br /> Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Owner <br /> (Circle One) <br /> Account Name RODNEY R SCHATZ <br /> Account Balance as of 7/26/2004: $0.00 (Circle One) <br /> Transfer to Active/Inactve <br /> New Owner? Delete <br /> Program/Element and Description <br /> Record ID Employee ID and Name Status <br /> 2244-PACT TRANSFER RECORD-OES PR0521630 EE0000000-HAZ MAT SJC OES 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,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: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />