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Date run 1/25/2006 2:59:15Ph SAN-<)P" UIN COUNTY ENVIRONMENTAL FY`-*'-%i DEPARTMENT Report#5021 <br /> Ren by 4006 Pagel <br /> Facility Information as of 1/2b/0006 <br /> Record Selection Criteria. Facility ID FAD002946 <br /> Make changes/corrections in RED Ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002199 New Owner 113 <br /> Owner Name DELTA WETLANDS <br /> Owner DBA DELTA WETLANDS <br /> Owner Address 3697 MT DIABLO BLVD 100 <br /> LAFAYETTE, CA 94549 <br /> Home Phone Not Specified <br /> Work/Business Phone 925-283-4216 <br /> Mailing Address 3697 MT DIABLO BLVD#100 <br /> LAFAYETTE, CA 94549 <br /> Care of KYSER FARMS <br /> FACILITY FILE INFORMATION <br /> Facility I FA0002946 <br /> Facility Name <br /> KYSER FARMS#3 39-99 <br /> Location W BACON ISLAND RD <br /> STOCKTON, CA 95206 <br /> Phone 209-464-7979 <br /> Mailing Address PO BOX 343 <br /> STOCKTON, CA 95201 <br /> Care of KYSER FARMS <br /> Location Code 99- UNINCORPORATED AREA APN: <br /> BOS District 003 - MOW, VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002508 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name KYSER FARMS#3 39-99 (Circle One) <br /> Account Balance as of 1/25/2006: $0.00 <br /> T (Circle One) <br /> Transfer to <br /> Active/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2755-EMPLOYEE HOUSING PR0270099 EE00010&4-STEPHANIE RAMIREZ Y N AI D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges assoda ad Mh this <br /> facility or activity wit be billed to the parry identified as the OWNER on this tom/. 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 /> APPLICANTS SIGNATURE: Date <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�yN�umber Received by <br /> REHS C 1 Date Account out: Date—Z <br /> COMMENTS: <br /> \\phschsgl-nt\apps\envis ions\reports\5021.rpt <br />