Laserfiche WebLink
Date run 5/16/01 1:44:23PM SAN QUIN COUNTY PUBLIC HEALTH SEP .S Report #: 0002 <br /> Run by Facility Information as of 5/16/01 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0007734 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0006397 New Owner ID <br /> Owner Name: EDMUNDSON, JOHN T <br /> Owner DBA: LAKESPUR ESTATES (PROPOSED) <br /> Owner Address: 4435 1 ST ST#338 <br /> LIVERMORE, CA 94550- <br /> Home Phone: 510-373-7300 <br /> Work/Bussness Phone: Not Specified <br /> Mailing Address: 4435 1 ST ST#338 <br /> LIVERMORE, CA 94550- <br /> Care of: JOHN T EDMUNDSON <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0007734 <br /> Facility Name: LAKESPUR ESTATES (PROPOSED) <br /> Location: 2025 S MACARTHUR DR <br /> TRACY, CA 95376 <br /> Phone• <br /> Mailing Address: PO BOX 6099 <br /> STOCKTON, CA 95206- <br /> Care of: DSS <br /> Location Code: 03 -TRACY APN; <br /> BOs District: 005- BEDFORD, LYNN SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0013576 New Account ID:: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: LAKESPUR ESTATES (PROPOSED) (Circle One) <br /> Account Balance as of 5/16/01: $0.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name St tus Linked New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0507203 EE0000684-INFURNA Act e 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, <br /> PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all <br /> operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to R SFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number / Receipt Number Received by <br /> REHS: Date l l(D / Account out: t Date 0& 1 l <br /> GUMVILN IS: <br /> 1.0.0.89.00 <br />