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HD i <br /> pxSIE 7 <br /> in County 10/1419 - ~YYcorreCt1 te) <br /> San �oagT1ON as o� - - N~r e chanVAr ON CHANGE as e1 <br /> ORMA - ^Mak <br /> Y 1NF INFOT S lP CHANGE (d <br /> STAFF FAC1T'1T _ OBER <br /> .� by - - <br /> _ - w Owner YD. DO <br /> TION Ne <br /> OWNER FILE INI`'OV24N <br /> CE CO OF A1vlE <br /> 13 L IN S <br /> OWNER ID: p UDENT R <br /> PR RANCH <br /> Owner Name= 400 <br /> Owner DBA: D108AN FRESNO g3720 <br /> Owner Address : FRESNO, CA <br /> 209-437-0190 <br /> Home phone ' FID22-1211670 <br /> Soc Sec# I Ta- ID# ' 01 <br /> TCORPORATION <br /> Ownership fie ' FRESNO ST 400 <br /> Mailing Address <br /> 7108 N OF AMERICA <br /> PRUDENTIAL INS CO <br /> Care of FRESNO, CA 93720 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007643 <br /> Facility 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 /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0012837 New Account ID: 000 <br /> Mail Invoices to: Facility Mail Invoices to : Owner-/ F <br /> Account Name : DURHAM RANCH (Ci <br /> Account Balance as of 10/14/97 : $-234 . 00 <br /> Record <br /> P/E Description ID Employee Status <br /> ------------------- ---------------- - <br /> 2951 UGT-CAP <br /> PR506469 0684 INFURNA ACTIVE ` <br /> ------------------ ---------------- <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or a <br /> project specific PHS/EHD hourly charges associated with this facility or activit <br /> BILLING PARTY on this form. I also certify that all operations will be performed <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws . <br /> APPLICANT' S SIGNATURE: Date / <br /> ------------------------ --------- <br /> ------------- <br /> PR Records to be TRANSFERED: x $20 . 00 = Amount Paid <br /> Water System to be TRANSFERED: x $150 . 00 = Amount Paid <br /> Payment Type Check ## <br /> REHS or COUNTER SUPV: Date / / ACCT out : Date / / UNI <br />