Laserfiche WebLink
Date Run 9/18/2025 4:47:02 PM SAN.IOAQ111N COUNTY ENVIRONMENTAL. HEALTH DEPARTMENT Report5021 <br /> Run By KLINHARES Facility Information as of 9/18/2025 Paget <br /> Record Selection Criteria: Facility ID FA0001222 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) S <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Facility Owner Number 4476204 SSN /Fed Tax ID: <br /> Facility Owner Name RIVER ISLANDS HIGH SCHOOL New Owner ID: <br /> Facility Owner DBA RIVER ISLANDS HIGH SCHOOL <br /> Facility Owner Address 22345 EL RANCHO RD <br /> LATHROP, CA 95330 <br /> Work/Business Phone 2098514815 <br /> Alternate Phone <br /> Mailing Address 22345 EL RANCHO RD <br /> LATHROP, CA 95330 <br /> Care of BANTA USD <br /> FACILITY FILE INFORMATION APN <br /> Facility ID/CERS ID FA0001222 <br /> Facility Name RIVER ISLANDS HIGH SCHOOL <br /> Facility Address 16601 RIPTIDE WAY <br /> LATHROP, CA 95330 <br /> Phone 2098514815 <br /> Mailing Address 22345 EL RANCHO RD 2 <br /> TRACY, CA 95304 <br /> Care of BANTA USD <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Emergency Contact RIVER ISLANDS HIGH SCHOOL u v <br /> Title FACILITY OWNER SEP 19r29� <br /> Primary Phone 2098514815 <br /> Secondary Phone ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Accounts Receivable ID 4476202 <br /> Mail Invoices to BANTA USD <br /> Contact Name RIVER ISLANDS HIGH SCHOOL <br /> Email invoice to(up to 2 emails) v�1CA�j�� �n�_�_t_,_ _ . ,Sr <br /> Email permit to(up to 2 emails) Q pt sAl , 065 �1 <br /> (1 <br /> Account Balance as of 9/18/2025: $172.00 <br /> Program Element and Description Record ID Employee ID and Name Status Transfer to (circle one) <br /> New Owner? Activellnactive0elete <br /> 1632-EXEMPT FOOD PR2400338 KLINHARES-KADEANNE LINHARES Active,billable Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT; 1,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this facility or activity <br /> will be billed to the parry Identified as the OWNER an this form. I also certify that all operations will be performed in accordance withal I applicable Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFEFRED: '$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFEFRED: Amount Paid Date 1 1 <br /> Payment Type <br /> 1 Check Number Received by }� <br /> EHD Staff: `, ` +�` ��e5 Date 1� 1 ZSAccount out: Date! ! `� <br /> COMMENTS: INVOICE#: <br />