Laserfiche WebLink
Date run : 2/13/01 3:38:10PM SAN AQUIN COUNTY PUBLIC HEALTH SER�`iS Report #: 0002 <br /> Ruh by : AYOUNGBLOOD <br /> Facility Information as of 2/13/01 ..► Page #: t <br /> Record Selection Criteria: FacilityID FA0005324 <br /> Record ID <br /> Make changes/correctio to innk' r <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE (date) <br /> Owner ID: OW0006512 New Owner ID <br /> Owner Name: ( -L..Agg- SI I I GOVI 1 ]A✓yl Ili 1 <br /> Owner DBA: I U 1l DYI S <br /> Owner Address: 400 INDUSTRIAL DR <br /> MANTECA, CA 95337- <br /> Home Phone: Dog_ a.:�q_ ti L4 y U <br /> Work/Bussness Phone: Not Specified <br /> Mailing Address: 400 INDUSTRIAL DR <br /> MANTECA, CA 95337- <br /> Care of: n_n <br /> C R -� <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0005324 <br /> Facility Name: 5 I I (,' 0 n I_ <br /> (A r-11 L f: .d slac-h Drug <br /> Location: 400 INDUSTRIAL PARK DR <br /> MANTECA, CA 95336 <br /> Phone: 209-825-8239 <br /> Mailing Address: 400 INDUSTRIAL PARK DR <br /> MANTECA, CA 95336- <br /> Care of: - ri <br /> Location Code: 04 - MANTECA APN; <br /> SOS District: 005- CABRAL, ROBERT SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0005786 New Account ID:: <br /> Mail Invoices to: Facility Mau Invoices to: OwneV Facility PAccount <br /> Account Name: ISE LABS INC (Circe ne) <br /> Account Balance as of 2/13/01: $758.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner7 Delete <br /> 2240-RCRA SM HW GEN<5 TONS/YR PR0220078 EE0007289-YOUNGBLOOD Active Y N A I D <br /> 2335-FARM UST#3 FACILITY PR0502089 EE0007289-YOUNGBLOOD Inactive 2 Y N A I D <br /> 2231-HAZARDOUS WASTE PBR FACILITY PR0507158 EE0007289-YOUNGBLOOD Active Y N A I D <br /> 2211-HAZ WASTE PBR FAC STATE SERVICE FEE PRO507159 EE0007289-YOUNGBLOOD Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FI PR0507160 EE0007289-YOUNGBLOOD Active Y N A I D <br /> BELLING and COMPLIANCE ACKNOWLEDGEMENT: I,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 /> 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 Type Check Number Receipt Number Received b <br /> RENS: Date / / Account out: ti- Date <br /> 1.0.0.89.00 <br />