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Date nin 10!1112005 9:34:21A SAN JOA I N COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/11/2005 <br /> Record Seiedion Criteria: Facility ID FA0015224 <br /> Make changeslcorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0012098 New Owner ID : <br /> Owner Name TREVOR, CATHERINE <br /> Owner DBA <br /> Owner Address 525 CLOUDVIEW DR <br /> WATERVILLE, CA 95076 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 525 CLOUDVIEW DR <br /> WATERVILLE, CA 95076 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015224 <br /> Facility Name TREVOR PROPERTY- UICISEPTIC <br /> Location 519 N PATTON AVE <br /> STOCKTON, CA 952151724 <br /> Phone <br /> Mailing Address 525 CLOUDVIEW DR <br /> WATERVILLE, CA 95076 <br /> Care of TREVOR, CATHERINE <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026155 New Account 0: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name TREVOR P�RO�RTY- UICISEPTIC (Circle one) <br /> Account Balance as of 1011112005: UY.00✓ <br /> (Circle One) <br /> Transfer to Activelinacive <br /> ee ID and Name Status New Owner? Delete <br /> Record ID Employee ProgremlElement and Description p Y <br /> 3030-UIC PROGRAM SITE PRO522351 EE0000684-MICHAEL INFURNA A ve Y N A I "D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/ project specific,PHS/EHD hourly charges associated with this <br /> fadllty or aetivity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accord nce with all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date 1 / <br /> Water System to be TRANS ED: '$372.00= Amount Paid Date 1 ! <br /> Payment Type heck Number Recei e <br /> REHS: Date 16 1_/ 1_ 0,:!7 Account out: Date 0 1 1 J2 <br /> COMMENTS. <br /> llphs-ehsq I-nthappsle nvisionslreports15021.rpt <br />