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Report#5021 <br /> Date run 8/17/2005 10:45:44AI SAN JOI&N COUNTY ENVIRONMENTAL HEAI�EPARTMENT Pagel <br /> Run by Facility Information as of 8/17/2005 <br /> Record Selection Catena: Facility ID FA0016368 <br /> Make changeslcorrections in RED ink or pencil. <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 RIVER ISLANDS/STEWART TRACT <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 SUSAN DELLOSSO, PRESIDENT <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 <br /> Location Code 07 - LATHROP APN: <br /> BOB District 005 -ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0028791 NewAccount ID: <br /> Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Account <br /> (Circle <br /> Account Name ENGEOINC <br /> Account Balance as of 8/17/2005: $-279.00 (Circle One) <br /> Transfer to Activellnactve <br /> New Omen Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2965-WATER QUALITY SITE PROJECT PR0524399 EE0000684-MICHAEL INFURNA 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 spedflc,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also cenify that all operations will be performed in accordance with all applicable Ordinace Codes andlor Standards and <br /> State anNor Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: _*$558.00= 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 />