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Date run 6/3/2002 10:01:27AM SAN JOAQUIN COUNTY Report #: 5023 <br /> Run by Facility Information as of 9/3/2002 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0012937 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0010111 New Owner ID <br /> Owner Name: MONIER LIFETILE LLC <br /> Owner DBA: <br /> Owner Address: 7575 IRVINE CENTER DR STE 100 <br /> IRVINE, CA 92618 <br /> Home Phone: 949-756-1605 <br /> Work/Business Phone: 209-983-1600 <br /> Mailing Address: 7575 IRVINE CENTER DR STE 100 <br /> IRVINE, CA 92618 <br /> Care of: MICHAEL PENNY CEO <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0012937 <br /> Facility Name: MONIER LIFETILE LLC <br /> Location: 9508 S HARLAN RD <br /> FRENCH CAMP, CA 95231 <br /> Phone: 209-983-1600 <br /> Mailing Address: 9508 S HARLAN RD <br /> FRENCH CAMP, CA 95231 <br /> Care of: <br /> Location Code: APN: <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0021682 New Account ID: <br /> Mail Invoices to: Acippurif JI.A-�— Mail Invoices to: Owner/Facility/Account <br /> Account Name: MONIER LIFETILE LLC (Circle One) <br /> Account Balance as of 9/3/2002: $89.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PR0516935 EE0000942-MARGARET LAGORIO 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: "$150.00= Amount Paid Date <br /> Payment Type Check Number Credit Card Number Received by <br /> REHS: / I\ Date 2/ 3 / d 2 Account out: Date 9/ 6V <br /> COMMENTS: <br /> \\phs-e hsgl-nt\apps\envisions\reports\5023.rpt <br />