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Date run 10/14/2003 1:12:24F SAN: 'QUIN COUNTY ENVIRONMENTAL Hr TH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/14/2003 <br /> Record Selection Criteria: Facility ID FA0014798 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010479 New Owner ID <br /> Owner Name TRIMARK COMMUNITIES <br /> Owner DBA <br /> Owner Address 3120 TRACY BLVD STE A <br /> TRACY, CA 95376 <br /> Home Phone 209-836-1560 <br /> Work/Business Phone 209-836-1759 <br /> Mailing Address 3120 TRACY BLVD STE A <br /> TRACY, CA 95376 <br /> Care of STANLEY PLOOF <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014798 <br /> Facility Name MOUNTAIN HOUSE NEIGHBORHOOD E <br /> Location MASCOT& MARINA BLVD <br /> TRACY, CA 95376 <br /> Phone <br /> Mailing Address 3120 TRACY BLVD <br /> TRACY, CA 95376 <br /> Care of STANLEY R PLOOF <br /> Location Code 03 -TRACY APN:209-050-08 <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025211 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SHELL OIL COMPANY (Circle One) <br /> Account Balance as of 10/14/2003: $-8.90 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0521796 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 Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />