Laserfiche WebLink
Date run 11/4/2003 11:14:01AI SAN JOIN COUNTY ENVIRONMENTAL HEALbEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/4/2003 <br /> Record Selection Criteria: Facility ID FA0014673 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011682 New Owner ID <br /> Owner Name RANCHOD, AJAY <br /> Owner DBA RANCHOD PROPERTY <br /> Owner Address 4225 E HAMMER LN <br /> STOCKTON, CA 95212 <br /> Home Phone 209-952-6911 <br /> Work/Business Phone Not Specified <br /> Mailing Address 4225 E HAMMER LN <br /> STOCKTON, CA 95212 <br /> Care of RANCHOD, AJAY <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0014673 <br /> Facility Name RANCHOD PROPERTY <br /> Location 18043 S MANTHEY RD <br /> LATHROP, CA 95330 <br /> Phone <br /> Mailing Address 4225 E HAMMER LN <br /> STOCKTON, CA 95212 <br /> Care of RANCHOD AJAY <br /> Location Code 07- LATHROP APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION j <br /> i <br /> Account ID AR0024962 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name RANCH RTY (Circle One) <br /> Account Balance as of 11/4/200 74.40 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and NameStatu New Owner? Delete <br /> 3030-UI CONTROL PROG SITE PR0521597 EE0000684-MICHAEL INFURNA Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,an rAlive <br /> roject specific.PHS/EHD hourly charges associated 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 accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. - - <br /> APPLICANT'S SIGNATURE: Date <br /> I <br /> Program Records to be TRANSFE ED: '$20.00= Amount Paid Date <br /> Water System to be N ER D: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date0 / Account out: Date / /_V7 <br /> COMMENTS: <br /> i <br /> f <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt_ <br />