Laserfiche WebLink
Date run 8/25/2008 3:16:56PN SAN JOA COUNTY ENVIRONMENTAL HEALTOEPARTMENT Report x5021 <br /> Run by 5290 Paget <br /> Facility Information as of 8/25/2008 <br /> Record Selection Crileda: Facility ID FA0018307 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0012728 New Owner ID <br /> Owner Name RICHLAND PLANNED COMMUNITIES <br /> Owner DBA <br /> Owner Address 2220 DOUGLAS BLVD STE 290 <br /> ROSEVILLE, CA 95661 <br /> Home Phone 916-782-3330 <br /> Work/Business Phone Not Specified <br /> ..��. <br /> Mailing Address 2220 DOUGLAS BLVD <br /> ROSEVILLE, CA 95661 <br /> Care of RICHLAND PLANNED COMMUNITIES <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0018307 <br /> Facility Name MAIN STONE PROPERTY-WSI/LLC <br /> Location 1221 W LORENZEN RD <br /> TRACY, CA 95304 <br /> Phone <br /> Mailing Address 2220 DOUGLAS BLVD <br /> ROSEVILLE, CA 95661 <br /> Care of RICHLAND PLANNED COMMUNITIES <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 005-ORNELLAS, LEROY Fax <br /> APN 23913003 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032240 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name MAIN STONE PROPERTY-WSI/LLC (Circle One) <br /> Account Balance as of 8/25/2008: $0.00 <br /> (Circle One) <br /> Transferto Active/InacIve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2965-WATER QUALITY SITE PROJECT PR0527013 EE0000664-MICHAEL INFURNA A ve Y N D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and r project spec,PHS/EHD hourly charges assoa d 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 a ante with all applicable Ordinace Codes and/or Standards and <br /> State andtor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to b NSF RED: "$372.00= Amount Paid Date / / <br /> Payment Type Check Number Rec od� <br /> REHS: Date / / 60 Account out: Date <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />