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J ' <br /> �i <br /> Run by_ STAFF San Joaquin County PHS/EHD Report #5021 <br /> FACILITY- <br /> OWNER FILE INFORMATION INFORMATION as of 08/05/97 <br /> ------------- <br /> - --- Make changes/corrections in RED pen or pencil: <br /> INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: O 0 4 8 51 New Owner ID: -O O <br /> Owner Name: BOGGETTI, ROB -' & SON a <br /> Owner DSA: ROBERT BOGG I & SON <br /> Owner Address: 700 W L E RD <br /> TRACY, A 95376 <br /> Home Phone: <br /> Soc Sec# / Tax 1D#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: PO B�CAGG]95376 <br /> Care of: ROBETTI & SON <br /> T Y, <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 006083 <br /> Facility Name: <br /> Location: 700 W LINNE RD { <br /> TRACY 95376 <br /> Phone: <br /> Mailing Address: PO BOX 797 <br /> Care of: ROBERT BOGGETTI & SON <br /> TRACY, CA 95376 <br /> Location Code: APN: <br /> BOS District: 005 SIC Code: - ? <br /> �I <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: '0007080New Account ID: 000 <br /> Mail Invoices to: Account :. t; Mail Invoices to: Owner ,,/ Facility / Account <br /> Account Name: (Circle one) . <br /> Account Balance as of 08/05/97 : $569 .40 (Circle one) <br /> Record UST(s) ' Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status 'Linked new owner? Delete <br /> ------------------------------------------------------------ ----------- ---------- <br /> 2333 FARM UST #1 FACILITY PR504114 1968 YOSHIOKA INACTTVE 4 Y N A I D <br /> 2951 UGT-CAP PR506469 0684 INFURNA ACTIVE Y N A I D <br /> ---------------------------------------'----------------------------------------" <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned.ewner, operator or agent of same, acknowledge that all site.and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN'JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> ------------------------ --------------- - --------- ------ -------- - ----- ----------- <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid Date <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Date <br /> Payment Type Check # Recvd by <br /> REHS or COUNTER SUPV: Date_/ / , ACCT out: :)ate-/-/ UNIT/File: / / <br />