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Date run : 12/11/00 10:09:43AM SAN , QUIN COUNTY PUBLIC HEALTH SER' S Report #: 0002 <br /> Run by MINFURNA Facility Information as of 12/11/00 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0008119-0008119 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0006712 New Owner ID <br /> Owner Name: GRANTLINE ROAD TRACY ASSCS <br /> Owner DBA: % COLLIERS INTERNATIONAL <br /> Owner Address: 5050 HOPYARD BLVD STE 180 <br /> PLEASANTON, CA 95488- <br /> Home Phone: Not Specified <br /> Work/Bussness Phone: 925-463-2300 <br /> Mailing Address: 5050 HOPYARD BLVD STE 180 <br /> PLEASANTON, CA 95488- <br /> Care of: GRANTLINE ROAD TRACY ASSCS <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0008119 <br /> Facility Name: HOME DEPOT <br /> Location: W GRANT LINE RD <br /> TRACY, CA 95376 <br /> Phone: 818-382-1806 <br /> Mailing Address: 650 TOWN CENTER DR 20TH FL <br /> COSTA MESA, CA 95488- <br /> Care of: ANNA AMARANDOS <br /> Location Code: 03-TRACY APN; <br /> BOS District: 005-CABRAL, ROBERT SIC Code. <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0015485 New Account ID:: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/ Facility/Account <br /> Account Name: HOME DEPOT (Circle One) <br /> Account Balance as of 12/11/00: $0.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0508504 EE0000684-INFURNA Active Y N A U <br /> D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,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 BILLING PARTY on this <br /> form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal <br /> Laws. <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment T e Check Number Receipt Number Received by <br /> REHS: Date / / Account out: Date -5 / /D <br /> CX-1 /z/,�loG <br /> 1.0.0.89.00 <br /> oRiGiNAL <br />