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Date run 9/26/2005 1:36:53PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/26/2005 <br /> Record Selection Criteria: Facility ID FA0015261 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011514 New Owner ID <br /> Owner Name LARO COAL& IRON CAL CO <br /> Owner DBA <br /> Owner Address PO BOX 245 <br /> LATHROP, CA 95330 <br /> Home Phone 925-314-3800 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 245 <br /> LATHROP, CA 95330 <br /> Care of LARO COAL& IRON CAL CO <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015261 <br /> Facility Name LATHROP MOSSDALE INVEST/REITER PRC <br /> Location 1520 E LATHROP RD <br /> LATHROP, CA 95330 <br /> Phone <br /> Mailing Address 675 HARTZ AVE STE#300 <br /> DANVILLE, CA 94526 <br /> Care of MIKE BADNER <br /> Location Code 07- LATHROP APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026267 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name LATHROP MOSSDALE INVEST/REITER PROP (Circle One) <br /> Account Balance as of 9/26/2005: $0.00 <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 SITE PR0522427 EE0009488-JEFFREY WONG 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 /> Stale 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 <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 />