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Oa!" 8/712002 4:38:09PM SAN J0/ '11N COUNTY ENVIRONMENTAL IIEAI -DEPAWl'INENT Report 9` 21 <br /> .*un b/ Paget <br /> W Facility Information as of 8/7/201 <br /> Record Selection CR". Facility to FA0003155 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(dale) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION _ fJ <br /> t' ��Q)/•(LS /let i - r J <br /> Owner ID OW0002353 New Owner ID : <br /> Owner Name KPILT11491IFF, KORINNE <br /> Owner DBA THE OASIS CAFE <br /> Owner Address_p$-;g�(_y={O6 <br /> TRACY, CA <br /> Home Phone 209-545-3146 <br /> Work/Business Phone 209-835-3182 <br /> Mailing Address `ISP' <br /> TRACY, CA- <br /> Care of KOLTHOFF, KORINNE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003155 <br /> Facility Name THE OASIS CAFE & MARINA STORE <br /> Location 12450 W GRIMES RD <br /> TRACY, CA 95376 <br /> Phone 209-835-3182 <br /> Mailing Address_F4); i- <br /> TRACY, CA 9537 I++96- <br /> Care of KOLTHOFF, KORINNE <br /> Location Code 03 -TRACY APN: <br /> BOS District 005- BEDFORD, LYNN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002720 New Account ID: : <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name THE OASIS CAFE 81 MARINA STORE (Circle One) <br /> Account Balance as of 8/7/2002: $0.00 <br /> Trarnler to (Cowie Ons) <br /> AO NNIOa We <br /> ProgramMlerrmM and Ooscrlplim Record ID Empoyee ID arM Name Status NM'Owner? D Wle <br /> 1615-RETAIL MKT<2000 SO FT(PREPKGD ONLYPRO161213 EE0003361-MARIBEL FLOHRSCHU1Active Y N A 1 D <br /> 1 -RESTAURANTIBAR 51-100 SEATS PRO162217 EE0003361-MARIBEL FLOHRSCHUTAclive Y N A I D <br /> 2224 HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511593 EE0000000-HAZ MAT SJC DES Active Y N A 1 D <br /> 2390 ABOVEGROUND TANK(SPCC) PRO516731 EE0000451-STEVE SASSON Active Y N A I D <br /> 2399 UNIFIED PROGRAM FAC STATE SERVICE FPRO509305 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> -TNC WATER SYSTEM(ORTLY) WA0460998 EE0000753-WILLIE NG Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Iha urgorslgned,carer,operator or ags,d of same,ackrxwAsdge Ina!as site,anMor prgect spe0irr.,PHS/EI ID nnnty charge,ass i,,"wen Ihls <br /> Sawa n o,re we ba need to the party IdeMilled as the OWNER an this!arm. I also certify Thal all operallons we be performed In accordance with all applkable Ordinace Codes ardor Standards aro <br /> Stale anNw Federal Laws. <br /> APPLICANT'S SIGNATURE: - Dale <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Dale <br /> Water System to be TRANSFERED: •$155.00= Amount Paid Date <br /> Payment Type Check Number Race(veQby <br /> REHS: Date / /_ Account out: Date _/ / <br /> COMMENTS: <br /> \\Phs-ehsol-nt\apps\E nvi sions\Reports\5021.rpt <br />