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Date run 5/16/2002 10:49:52AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/16/2002 <br /> Record Selection Criteria: Facility ID FA0013830 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> DWNER FILE INFORMATION <br /> Owner ID OW0010927 New Owner ID <br /> Owner Name KIKUCHI, DANIEL/KITASOE, LORRA <br /> Owner DBA <br /> Owner Address 2291 W MARCH LN A101 <br /> STOCKTON, CA 95207 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1301 W LOCKEFORD ST <br /> LODI, CA 95242 <br /> Care of <br /> -ACILITY FILE INFORMATION <br /> Facility ID FA0013830 <br /> Facility Name KIKUCHI/KITASOE PROPERTY <br /> Location 1301 W LOCKEFORD ST <br /> LODI, CA 95242 <br /> Phone <br /> Mailing Address 2291 W MARCH LN STE A101 <br /> STOCKTON, CA 95207 <br /> Care of <br /> Location Code 02 - LODI APN: <br /> BOS District SIC Code: <br /> kCCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0023277 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SHARD .BE—NSOt CACONE (Circle One) <br /> kccount Balance as of 5/16/2002: $-267.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> rogram/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 950-ENVIRON ASSESS PRO518316 EE0000684-MICHAEL INFURNA Active Y N A UD <br /> ILLING 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 /> icility 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 /> tate and/or Federal Laws. <br /> ,PPLICANT'S SIGNATURE: Date <br /> rogram Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Vater System to be TRANSFERED: '$155.00= Amount Paid Date / / <br /> 'ayment Typ Check Number Received by <br /> :EHS: Date 1 / 6 Z_ Account out: Date <br /> OMMENTS: <br /> Ole -7 <br /> 'hs-ehsgl-nt\apps\Envisions\Reports\5021.rpt FILE COPY <br />