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Date run 8/1/2007 11:14:43AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Pagel <br /> Run by Facility Information as of 8/1/2007 <br /> Record Selection Cnlerta: Facility ID FA0016368 <br /> Make changes/corrections in RED ink or pencil. <br /> FILE <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0013244 New Owner ID <br /> owner Name CALIFIA LLC <br /> owner DBA <br /> Owner Address 73 W STEWART RD <br /> LATHROP, CA 95330 <br /> Home Phone 209-879-7900 <br /> Work/Business Phone Not Specified <br /> Mailing Address 73 W STEWART RD <br /> LATHROP, CA 95330 <br /> Care of DELLOSSO, SUSAN PROJECT DIR <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016368 <br /> Facility Name RIVER ISLANDS/STEWART TRACT <br /> Location STEWART RD <br /> LATHROP, CA 95330 <br /> Phone 209-879-7900 <br /> Mailing Address 73 W STEWART RD <br /> LATHROP, CA 95330 <br /> Care of CALIFIA LLC APN: <br /> Location Code 07- LATHROP <br /> BOS District 005-ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0028791 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner I Facility / Account <br /> Account Name ENGEO INC (Circle One) <br /> Account Balance as of 8/1/2007: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inaclve <br /> Nev,Owner? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2965-WATER QUALITY SITE PROJECT PRO524399 EE0000684-MICHAEL INFURNA Active Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator of agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges associated!Alt this <br /> facility or activity will be billed to the party Identified as the OWNER on this form. I also certify that all operations wilt 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 I ! <br /> Water System to be NSFERED: -*$372.00= Amount Paid Date <br /> Payment Type Check NumberReceived by <br /> REHS: Date I_/ Account out.. <br /> Date <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />