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Ke <br /> Pagel <br /> Dale run 71612006 10:35:50AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Facility Information as of 716/2006 <br /> Run by <br /> Record Selection Criteria: Facility ID FAGO16640 Make changeslcorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) — <br /> OWNERSHIP CHANGE(date) — <br /> OWNER FILE INFORMATION New Owner ID <br /> Owner ID OW0013244 <br /> owner Name CALIFIA LLC <br /> Owner DBA <br /> Owner Address 73W ST <br /> E <br /> LATHROP, CA 953WART D30 <br /> Home Phone 209-879-7900 <br /> Work/Business Phone Not Specified <br /> Mailing Address 73 W STEWCA RD <br /> 30 <br /> LATHROP, <br /> Care of DELLOSSO, SUSAN PROJECT DIR <br /> Site Mitigation Facility <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016640 <br /> Facility Name CORPORATION EQUIPMENT YARD <br /> Location 1417 W STEWART RD <br /> LATHROP, CA 95330 <br /> Phone 209-879-7900 <br /> Mailing Address 73 W STEWART <br /> RD <br /> LATHROP, CA 95330 <br /> Care of DELLOSSO, SUSAN APN21324002 <br /> Location Code 07 -LATHROP SIC Code: <br /> BOIS District 005- ORNELLAS, LEROY <br /> ACCOUNTS RECEIVABLE FILE INFORMATION New,Account ID: <br /> Account ID AR0029450 Mail Invoices to: Owner / Facility / Account <br /> (Circle One) <br /> Mail Invoices to"ai <br /> Account Name CORP EQUIPMENT YARD <br /> (Circe One) <br /> Transferto Active/InacNe <br /> Account Balance as of 71612006: $7D /L#3 New Owner? Delete <br /> status <br /> Record ID Employee ID and Name Y N A I D <br /> programlElement and Description <br /> 2950-ENVIRON ASSESS <br /> PR0524785 EE0000664-MICHAEL INFURNA Active <br /> identified as the OWNER on this form. I also to roc that all operations will be ge that ed si accordance with all applicable ONinace Codes and/or Standards and <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent or same,acknowlatlge that all site,antllor project-Pacific PHS/EHD hourly charges associated with �s <br /> fatality or activity will be billed to the party' <br /> State and/or Federal Laws. <br /> Date _/—/— <br /> APPLICANT'S SIGNATURE: Amount Paid Date <br /> $20.00= Date_/—/— <br /> program Records to be TRANSFERED: .$372.00= Amount Paid <br /> Water System to be T FERED: Received y <br /> Payment Type Check Number Date_ 7 <br /> Date---7l­­Account out: <br /> REHS: <br /> COMMENTS: <br /> �� � P � <br /> PAA <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />