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Jan. 14. 2008 9:41AM 20'SALVADOR GONZALEZ LABOR 'CONTRACTiMENTAL HEALTH No. 6157 P. 1AGE 02/02 <br /> tzl2 <br /> u[e12/2&2007 8:41:15ARSAN__,iQUiN.COUNTY ENVIIRo 11NMNTAL HEAL DEPARTMENT <br /> Run by � Repon asarl <br /> Facility Informaticrt as of 1212$/2.007 page' <br /> Record SeleakfN Grlhem Fadkv to �AOG'12769 <br /> aka ctsangAsleQrrec4roris fn RED ink or psncp. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATIOftf ~"���� OWNERSHIP CHANGE(date) - <br /> Owner ID OW0009948 New Owner ID <br /> f Owner lame! GONZALEZ, SALVADOR <br /> Osvrter DBA SALVADOR GONZALEZ LAEOR CONT <br /> Owner Address 213 FOURTH ST <br /> GALT, CA 95632 <br /> Home Pnone 209-745-2223 <br /> WorkMusiness Phone No!Specified <br /> Mailing Address 217 FOURTH ST <br /> GALT, CA 95632 <br /> Care of GONZALEZ,SALVADOR <br /> FACILITY FILE INFORMATION <br /> F9011ty)D FA0012769 <br /> Feeility Name SALVADOR GONZALEZ LABOR CONTR ACT <br /> Location 10005 KOST RD <br /> GALT,CA 95632 <br /> Pnona 209-745-2223 <br /> MailingAddress 217 FOURTH ST <br /> GALT, CA 95632 <br /> Caro of <br /> L.00ction CDde 99-i~INIMCORPORATEO AREA APN: <br /> SO$District 004-VOGEL, KEN 310 Code: <br /> ACCOUNTS REGE(VABLE FILE INFORMATION <br /> A=*-nt ID AR0021369 Now Acwunt to: : <br /> I1M0 Invoices to Facility Mail Invotcem to: pwner r F20 ty t Aconunt <br /> AcccuntNarne SALVADOR GONZALEZ LABOR CONTRACTOR rClydaone <br /> Account Balance as of 12/2M007: $185.75 <br /> Tranarer to (CVIS one) <br /> Proprarn/Ebmrmt and DOSCrfpUM1 R NMs C)~ Aeov"T"Cwe <br /> saor'0 ID Fcmpb�ri 1D Md Noma gc#ax Oetese <br /> 4244-PUMPER TRUCK PRO516744 EECOO5366-L.15A ME12INA Active Y N A I D <br /> OW-CHEMICAL TOLLETS Pft4616745 EE0005366-LISA MEDINA Acture Y N A rfI D <br /> 91"o and ty win bJaNCE ACKN0 ny I Dfa'PMF:N7: 1,the Yndrralttned arrear Wtcor pr agent or a mg,m*mgwW@e MM all she,W4W yraoq;pedk PHSfEHD Iqurl�dmrgg;amliii o�ilh y,1� <br /> ror.Aayr o*ea1Mry win be btlled fo>!ta Pp7�Wars ar9 VYH art ih7s fa t Mea Cerny mos ea oae.du�wtl ba pe+tamee to accordance trMh ak oNe9bre 0MIneoa Codff endAw 61andW%and <br /> 3�aSa anar�Feaerei LaNra_ <br /> APPLICANTS SIGNATURE: Date " I 1I; 1. OV <br /> PrOgfam RACords to be TRANSF'EREQ: -S .00= Amount Paid <br /> Water Sy a to be SFERED: •5372.00= Amount Pald <br /> Date ! i <br /> Pay ~ <br /> G±+eck Number Rec� d by <br /> RE D2te -l- .Accouroom: <br /> CC�rM 9� <br /> i <br /> i <br /> i <br /> [Sphs-8fle3gl.nitappslenvlcion$tin;porls15n2t,rpt ' <br />