Laserfiche WebLink
0Run by : JIM 1 Joaquin County PHS/EHD 0 Report #5021 <br /> FACILITY INFORMATION as of 01/04/96 <br /> ------------------------------------------------------------------------------- <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): " b <br /> OWNERSHIP CHANGE (date): <br /> OWNER ID: 000550 New Owner ID: 00 <br /> owner Name: SKS ENTERPRISE <br /> Owner DBA: SKS ENTERPRISE <br /> Owner Address: 11830 FRENCH CAMP RD <br /> MANTECA, CA 95366-9732 <br /> Home Phone: <br /> Work/Business Phone: <br /> Mailing Address: 11830 FRENCH CAMP RD <br /> care of: SKS ENTERPRISE <br /> MANTECA, CA 95366-9732 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 000693 <br /> Facility Name: SKS ENTERPRISE INC <br /> Location: 17250 E DODDS RD <br /> RIPON 95366 <br /> Phone: <br /> Mailing Address: 12 2 <br /> care of: SKS ENTERPRISE INC ^^ (� <br /> anis O , CA---,9-5-3"----� `P1 �l'V33�► <br /> Location Code: 0 5 APN: <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0000692 New Account ID: 000 <br /> Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name: SKS ENTERPRISE INC (circle one) <br /> Account Balance as of 01/04/96: $90.00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ------------------------------------------------------------------------------- <br /> 4041 POULTRY RANCH 50000-99000 BIRD PR400033 9157 BARCELLOS ACTIVE Y N A I D <br /> ------------------------------------------------------------------------------- <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> ------------------------------------------------------------------------------- <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid Date <br /> Water System to be TRANSFERED: -_ x $150.00 = Amount Paid Date—/—/ <br /> Payment Type Check # Recvd by <br /> RENS or COUNTER SUPV: Date '1 ACCT out: Date I' UNIT/File: / / <br />