Laserfiche WebLink
Date run : 5/18/00 9:05:34AM QUIN COUNTY PUBLIC HEALTHES Report #: 0002 <br /> Run by VPEDRAZA AW Facility Information as of 5/18/00 Page #: 1 <br /> Record Selection Criteria: FacilityID FA0010400 <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; OW0008400 Case Number: H08018 New owner ID <br /> Owner Name; CSK AUTO INC <br /> Owner DBA: <br /> Owner Address• <br /> Home Phone; Not Specified <br /> Work/Bussness Phone; 602-265-9200 <br /> Mailing Address; PO BOX 6030 <br /> Care of• <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0010400 <br /> Facility Name: KRAGEN AUTO PARTS#1137 <br /> Location; 430E CHEROKEE LNUkA <br /> LODI, CA 95240 20 <br /> Phone; 209-333-1195 <br /> Mailing Address: PO BOX 6030 <br /> Care of; SUSAN HANNS <br /> Location Code: 02- LODI APN; 047-450-31 <br /> BOS District; 004- SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID; AR0017400 New Account ID:; <br /> Mail Invoices to; Account Mail Invoices to; Owner/Facility/Account <br /> Account Name; KRAGEN AUTO PARTS#1137 (Circle One) <br /> Account Balance as of 5/18/00: $110.00 <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 /> � PRO514311 EE0006213-PEDRAZA Active Y N A I D <br /> 2226-CaIARP PROGRAM PR0514776 EE0000000-SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FI PRO510400 EE0000000-SJC OES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512688 EE0000000-SJC DES Active Y N A I D <br /> I� 1 use of L ACKNOWLEDGEMENT:L G and COMPLIANCE ACKNO EDGEMENT: I,the undersigned owner,operator or agent ofsame,acknowledge that all site,and/or <br /> project specific,PHS/EHD hourly charges associated with this facigty 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 /> APPLICANTS 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 T7Ype Check Number Receipt Number Receivea by <br /> REHS: V t"'R- Date / /jq() Accountout: Date feo /x'! <br /> UUMMEN 16: <br /> 1.0.0.89.00 <br />