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Runby : STAFF San Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 02/21/97 <br /> ------------------------------------------------------------------------------- <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID-. 005798 New Owner ID: 0 0 <br /> Owner Name: MOUNTAIN VIEW TOWNHOMES <br /> Owner DBA: <br /> Owner Address: 2125 19TH STREET <br /> SACRAMENTO, CA 95818 <br /> Home Phone: <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 2125 19TH STREET <br /> Care of: <br /> SACRAMENTO, CA 95818 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007056 <br /> Facility Name: T <br /> Location: 413 MT DIABLO <br /> TRACY 95236 <br /> Phone: <br /> Mailing Address: 4000 EXECUTIVE PARKWAY <br /> Care of: SAN RAMON, CA 94583-0959 `OEs L <br /> Location Code: 0 3 APN: <br /> BOS District: 005 SIC Code: <br /> Y2- 3 w- <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> 5tZ <br /> ACCOUNT ID: 0010185 New Account <br /> Mail Invoices to: Account Mail Invoices to: Owner / Facility / Account <br /> Account Name: EMCON (Circle one) <br /> Account Balance as of 02/21/97 : $46 . 80 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ------------------------------------------------------------------------------- <br /> 2960 RWQCB CLEAN UP SITE PR505861 0684 INFURNA 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 /> REHS or COUNTER SUPV:�/ Date ?// 2, ACCT out: Date % UNIT/File: / / <br />