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Run by ; STAFF San Joaquin County PHS/EHD Report <br /> --FACILITY-INFORMATION as of 12/18/98 <br /> --- ---- --- --- ----- <br /> OWNER FILE INFORMATION <br /> Make changes/corrections in RED pen or pencil: <br /> INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 006313 <br /> New Owner ID: 00 <br /> Owner Name: PRUDENTIAL INSURANCE CO OF AME <br /> Owner DBA: DURHAM RANCH <br /> Owner Address: 7108 N FRESNO ST 400 <br /> FRESNO, CA 93720 <br /> Home Phone: 209-437-0190 <br /> Soc Sec# / Tax ID#: FID22-1211670 <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 7108 N FRESNO ST 400,1: <br /> care of: PRUDENTIAL INS CO OF: AMERICA <br /> FRESNO, CA 93720 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007643 <br /> Pacility Name: DURHAM RANCH <br /> Location: 700 W LINNE .RD <br /> TRACY 95376 <br /> Phone: 209-437-3242 <br /> Mailing Address: 7108 N FRESNO ST STE 401 <br /> Care of: CAPS <br /> FRESNO, CA 93720 <br /> Location Code: APN: <br /> BOS District: SIC Code: <br /> k <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT TD: 0012837 New Account ID: 000 <br /> Mail Invoices to: 'Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name: DURHAM RANCH <br /> (.Circle one) <br /> Account Balance as of 12/18/98 : $0 . 00 <br /> (Circle one) ' <br /> Record UST(s) Transfer to Activate / Inactivate J <br /> P/£ Description ID Employee Status ,Linked new owner? Delete <br /> ------------ ----- ----------------------------------------- ---- ---------- — ----- i <br /> 2951 UST-CAP PR506469 0684 INFURNA ACTIVE Y N A .I D <br /> i <br /> )fie <br /> L <br /> —————————————————————————————————————————————— ——————————————————————————————— — <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, 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 he 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 TRANSFER£D: 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 /> -------- ------- -------- - - - ----- -------- --- - ------ ---- - - --- {I <br /> REHS or COUNTER SUPV: Date 4r / ACCT out: Date _/ UNIT/File: <br /> !k <br />