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Run by : LAURIEB Sa�., Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 06/15/99 <br /> -- - ---------------- -------- ---- ------------------------------------------------ <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 006320 New owner ID: 00 <br /> owner Name: SUTHERLAND, KEN tjaxisso <br /> owner DBA: SUTHERLAND CO/SCOTT CO 157 M in JU4 gFix 'Liz <br /> Owner Address: 417 FOURTH ST 19,00 <br /> OAKLAND, CA 94607 my d- bj . q4D&2- <br /> Home Phone; 510-893-0772 <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 417 FOURTH ST biz A&Ve" <br /> care of: SUTHERLAND, KEN <br /> OAKLAND, CA 94607 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007652 <br /> Facility Name: STEEL GUARD <br /> Location: 15700 MCKINLEY AVE <br /> LATHROP 95330 <br /> Phone: <br /> Mailing Address: 417 FOURTH ST j�S QbD✓ <br /> care of: KEN SUTHERLAND <br /> OAKLAND, CA 94607 <br /> Location Code: 9 9 APN: <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0012914 New Account ID: 000 <br /> Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name: STEEL GUARD (Circle one) <br /> Account Balance as of 0 6/15/9 9 : $0 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ------------------------------------------------------------------------------- <br /> 2950 ENVIRON ASSESS PR506830 0997 KNOLL ACTIVE Y N A I D <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 be 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 TRANSFERED: 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 /> --------------------------- <br /> ______ ____ -------------------------------------------------- <br /> ACCT <br /> ------- <br /> ------------------------------ <br /> -------------------- <br /> REHS o-:- COUNTER SUPV: _ Date / ACCT out: Date f(! ''� /� UNIT/File: / / <br />