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Date run : 06/00 8:56:21AM SAN AUIN COUNTY PUBLIC HEALTH SERAW Report #: 0002 <br /> Rugby wDAVIS Facility Information as of 9/6/00 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0007466 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0006172 New Owner ID <br /> Owner Name: S W REALITY COMP INC <br /> Owner DBA: <br /> Owner Address; 6892 MARLIN CIR <br /> LA PALMA, CA 90623- <br /> Home Phone: 209-836-2151 <br /> Work/Bussness Phone: 714-521-9340 <br /> Mailing Address; PO BOX 5399 <br /> BUENA PARK, CA 90623- <br /> Care of: HUGHES, GEORGE <br /> FACILITY FILE INFORMATION <br /> Facility to: FA0007466 <br /> Facility Name: GEORGIA PACIFIC CORP (FORMER) <br /> Location; 75 W VALPICO RD <br /> TRACY, CA 95336 Cv P-wQ" <br /> Phone <br /> Mailing Address: 75 W VALPICO RD <br /> TRACY, CA 90623- <br /> care of; S W REALITY COMP INC <br /> Location Code: 03-TRACY APN, <br /> BOS District: 005 -CABRAL, ROBERT SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR00 40 New Account ID:: <br /> Mail Invoices toCOUn Mail Invoices to: Owner/Facility/Account <br /> Account Name AND CALDWELL (Circle One) <br /> Account Balance as of 9/6/00: <br /> (Circle One) <br /> UST(s) Transferto Active/Inacty <br /> Program/Element and Description Recor ID Employee ID and Name Status Linked New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PR 06509 EE0000684-INFURNA Active Y N I <br /> BILLING and COMPLIANCE ACKNO WLEDGEAI T. I,the undersigned owner,operator or agent Of sonic,acknowledge that all site,andlorproject <br /> specific,PHSIEHD hourly charges associated w' is facility Or activity will be billed to the party identified as the BILLING PARTY on thisform. I <br /> also certify that all operations will be performe n accordance with all applicable Ordimce Codes and/or Standards and State and/or Federal Laws <br /> APPLICANT'S SIGNATURE: Date I / <br /> Program Records to be TRANSFERS . '$0.00= Amount Paid Date / / <br /> Water System to be TRANSFERED '$150.00= Amount Paid Dale <br /> Payment Type Check Number Receipt NumberReceived by <br /> REHS: Date / / Account out: V r✓ Date <br /> j+ce-oLt�j7 A-bDRiass : 3R,oa -I GA Lawai-L <br /> -row <br /> 3f 90 QLLS(-12(e- AVC �� : 2-01 N. C/t✓t c. <br /> l�Ldks�i7 �I V / /4 <br /> Sa <br /> 1.0.0.69.00 LSL N[ tj eo 1"`�`�0 1 e---) <br />