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Date run ,10130!2007 .9:45:00A SAN JOr, TIN COUNTY ENVIRONMENTAL HEA;- DEPARTMENT Report#5021 <br /> Run by 4006, `�+� Paget i <br /> Facility Information as of 10/30/2007 <br /> r Record Selection Criteria: Facility ID FA0000208 <br /> Make changes/corrections in RED ink or pencil. { <br /> INFORMATION CHANGE(date) <br /> f R OWNERSHIP CHANGE(da e <br /> OWNER FILE INFORMATION 1(.�I , <br /> Owner ID New Owne ID . <br /> Owner Name NEWPORT PACIFIC CAPITAL CO <br /> Owner DBA ARBOR MOBILE HOME PARK <br /> t OwnerAddress 17300 RED HILL AVE 280 <br /> IRVINE, CA 92714 <br /> Home Phone 209-369-2452 <br /> f <br /> Work/Business Phone 714-852-5575 <br /> I Mailing Address 17300 RED HILL AVE#280 <br /> IRVINE, CA 92714 <br /> Care of NEWPORT PACIFIC CAPITAL <br /> FACILITY FILE INFORMATIONfA DD1S <br /> Facility ID 6 <br /> Facility Name ARBOR MOBILE HOME PARK <br /> Location 19690 N HWY 99 <br /> ACAMPO, CA 95220 <br /> Phone 800-339-6722 <br /> Mailing Address 19690 N HWY 99 <br /> ACAMPO, CA 95220 <br /> Care of THE ARBORS <br /> Location Code 99- UNINCORPORATED AREA APN:01733007 <br /> BOS District 004-VOGEL, KEN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID New Account : ) p 0 �� <br /> IF— <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility ccount <br /> Account Name ARBOR MOBILE HOME PARK (cirdeOne) <br /> Account Balance as of 10/30/2007., $0.00 <br /> (Circle One) <br /> Transferto Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 3611 -PUBLIC POOL/SPA-PRIMARY PR0360004 EE0006213-VIDAL PEDRAZA Active Y N A I D <br /> 3612-PUBLIC POOLISPA-ADDITIONAL PR0360191 EE0006213-VIDAL PEDRAZA Active Y N A I D <br /> 4242-WASTE WATER TX PLANT PR0420fi02 EE0005366-LISA ME=DINA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the party 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 and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I I <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 Received by <br /> REHS: Date 1 1 Account out: Date 0! .3b!a <br /> COMMENTS: <br /> TA*0-:"5 4 Ls A SSE Ok-r&t, 7S �JG O <br /> - r <br />� I <br /> 154-0'r- <br /> 0 Lb <br /> 54-t'--.--ora J;+e- Lt. (A-0 7th-9-.s <br /> Ilphs-ehsgl-ntlappstenvisionsVeports15021.rpt <br />