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Date run 6/26/2003 9:10:10AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run J <br /> Pagel <br /> '4r Facility Information as of 6/26/2003 <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 <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 <br /> Account ID AR0024962 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name RANCHOD PROPERTY (Circle One) <br /> Account Balance as of 6/26/2003: $-534.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> New Owner? Delete <br /> 3030-UI CONTROL PROG SITE PR0521597 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project 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 /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: *$155.00= Amount Paid Date <br /> Payment Type '� Check Number OZ3a S Rece�ivgdd by <br /> REHS: Date / / Account out: V V Date /G34 / <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpilo.) <br />