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Rate ren 2/6/2003 3:18:37PM SAN JOArO�iTIN COUNTY ENVIRONMENTAL HEAL�DEPARTMENT Report#5021 <br /> Run by • Pagel <br /> Facility Information as of 2/6/20 <br /> Record Selection Criteria: Faci ity ID FA0007M <br /> Make changes/corrections in RED ink or per cil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner I OW0002996 New Owner ID <br /> Owner Name DDRW (SHARPE) <br /> Owner DBA <br /> Owner Address 850 ROTH RD <br /> LATHROP, CA 95330 <br /> Home Phone 209-982-2093 <br /> Work/Business Phone 904-332-3318 <br /> Mailing Address 2870 GATEWAY OAKS DR STE 300 <br /> SACRAMENTO, CA 958334324 <br /> Care of URS CORP ATTN RICHARD VAN DYKE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007648 <br /> Facility Name DDRW -SHARPIES <br /> Location 850 ROTH RD BLDG S-108 <br /> LATHROP, CA 95330 <br /> Phone <br /> Mailing Address 850 ROTH RD <br /> LATHROP, CA 95330 <br /> Care of PETER KALUSH (ASCW-BE) <br /> Location Code 07 - LATHROP APN: <br /> BOS District 003- MOW,VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID QR 869 New Account ID: <br /> Mail Invoices Account Mail Invoices to: Owner / Facility / Account <br /> ACCOUnt Nam 'T1e1+ (Circle One) <br /> Account Balance as of 2/6/2003: $1,379.50 <br /> (Grote One) <br /> Transferto gc[ive/InacNe <br /> New er? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2954-NPL/SEP SITE PROJECT PR0506824 EE0000997-HARLIN KNOLL 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 houry harges 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 Ccdes 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 />