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1:12:41AISAN J(1�QUIN COUNTY ENVIRONMENTAL HEA Pagel DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 9/1412 <br /> Record Selection Criteria: Facility ID FA0004006 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002948 New Owner ID <br /> Owner Name LEPRINO FOODS <br /> Owner DBA LEPRINO FOODS <br /> Owner Address 2401 MACARTHUR DR <br /> TRACY, CA 95376 0 <br /> Home Phone 800-537-7466 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 173400 <br /> DENVER, CO 802173400 <br /> Care of EWING, JOHN <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004006 <br /> Facility Name LEPRINO FOODS <br /> Location 2401 S MACARTHUR DR <br /> TRACY, CA 95376 <br /> Phone 209-835-8340 <br /> Mailing Address 2401 S MACARTHUR DR <br /> TRACY, CA 95376 <br /> Care of GREENGRASS, ROY <br /> Location Code 03 -TRACY APN 213-070-50-1 <br /> SOS District 005- ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003636 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name LEPRINO FOODS (Circle One) <br /> Account Balance as of 9/14/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactva <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0009269 EE0006219-LORI DUNCAN 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 speck,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to Me party identified as Me 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: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\p hs-ehsq I-n t\apps\envisions\re ports\5021.rpt <br />