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Date run 6/9/2006 10:41:57AM SAN UIN COUNTY ENVIRONMENTAL HEA 'j DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/9/2006 <br /> Record Selection Criteria: FactNy ID FA0016640 <br /> Make changes/corrections 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 <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 Site Mitigation Facility <br /> Facility ID FA0016640 yp , <br /> Facility Name CORPORATION EQUIPMENT YARD V Gl t V <br /> Location 1417 W STEWART RD �& /(i7v <br /> LATHROP, CA 95330 v <br /> Phone 209-879-7900 <br /> Mailing Address 73 W STEWART RD <br /> LATHROP, CA 95330 <br /> Care of DELLOSSO, SUSAN <br /> Location Code 07- LATHROP APN 21324002 <br /> BOS District 005- ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029450 New Account ID: <br /> Mall Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CORPORATION EQUIPMENT YARD (Circle One) <br /> Account Balance as of 6/9/2006: $0.00 <br /> (Circle One) <br /> Transfer to Active/inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0524785 EE0000684-MICHAEL INFURNA ' e Y N A I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,an /or project specific,PHS/EHD hourly charges asso atea with this <br /> facility or activity will be billed to the parry Identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State anter Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Recei.ed y 'l/ <br /> REHS: � Date / / Account out: Date_q/ S/� <br /> COMMENTS: <br /> 0 <br /> 61� <br /> 1\phs-ehsgl•nt\a ppsNenvis ionskreportsk502l.rpt <br />