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Runby : STAFF San Joaquin County P S/EHD Report #5021 <br /> FACILITY INFORMATION as of 12/12/97 <br /> -------------------------------------------- ---------------------------------- <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID; 006283 N w Owner ID: 00 <br /> owner Name: TRI STAR HOMES <br /> Owner DBA: TRI STAR HOMES <br /> Owner Address; 3200 DANV I LLE BLVD S TE 200 <br /> ALAMO, CA 94507-1914 <br /> Home Phone: <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: PO BOX 1056 <br /> Care of: MIKE GALLAGER <br /> ALAMO, CA 94507-1914 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007611 <br /> Facility Name: TRI STAR HOMES LOT 51 I—Aye - <br /> Location: <br /> TRACY 95376 <br /> Phone: <br /> Mailing Address: PO BOX 1056 <br /> Care cf: MIKE GALLAGER <br /> ALAMO, CA 94507-1914 <br /> Location Code: 0 3 APN: <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT Ir-. 0 0123 80 New Account ID: 000 <br /> Mail Invoices to: Facility M it invoices to: Owner / Facility / Account <br /> Account Name: TRI STAR HOMES LOT 51 {Circle one) <br /> Account Balance as of 12/12/9 7 : $0 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ---ID---- Employee---- ---Sta us -- Linked--new owner? - Delete--- <br /> 2 �------------------ - - ---��-_-- ------- <br /> ;--9-"f <br /> 9 UGT-CAP -PR506762 0684 INFURNA --- ACTIVE ----Y--N---- -O I D <br /> ---------------------- ----------- ----- ------------ <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> project specific PHS/RHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be pe formed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> PR Records to be TRANSFERED: x $20.00 - Amount Paid Date <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Date <br /> Payment Type Check # Recvd by <br /> REHS or COUNTER SUPV: Date'/i /� j/ ACCT out: Date/�(r/ UNIT/File: <br /> v <br />