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Date run 3/5/2003 2:50:59PM SAN JO QUIN COUNTY ENVIRONMENTAL HE H DEPARTMENT Report#5021 <br /> Run by t tt Facill'ty Information aJ�Mys of 3/5/2 Pagel <br /> LC <br /> 11 <br /> Record Selection Criteria: Facility ID FA0003768 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002798 New Owner ID <br /> Owner Name TAYLOR, RONALD W <br /> Owner DBA RON TAYLOR TOURS <br /> Owner Address 21426 E ACAMPO RD <br /> CLEMENTS, CA 95224 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-759-3270 <br /> Mailing Address P.O. BOX 404 <br /> CLEMENTS, CA 952270404 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003768 <br /> Facility Name RON TAYLOR TOURS T-LYe— vvt 6V F� �D <br /> Location 330 E KETTLEMAN LN <br /> LODI, CA 95240 <br /> Phone 209-333-8685 <br /> Mailing Address P.O. BOX 404 <br /> CLEMENTS, CA 952270404 <br /> Care of <br /> Location Code 02- LODI APN: <br /> BOS District 004-SEIGLOCK, JACK SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003347 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name TAYLOR, RONALD W (circle One) <br /> Account Balance as of 3/5/2003: $217.50 <br /> (Circle One) <br /> Transfer to <br /> Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PRO514440 EE0008389-DENNIS CATANYAG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0513157 EE0000000-HAZ MAT SJC OES Active Y N A D <br /> 2244-PACT TRANSFER RECORD-GES PRO521079 Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84) PR0232267 EE0003580-MICHELLE LE Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPRO507450 EE0003580-MICHELLE LE Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknovAedge that all site,and/or project specific,PHS/EHO hourly charges associated with this <br /> facility a activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordmace Codes andlor Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: _*$155.00=— Amount Paid Dav <br /> Payment Type Check Number by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> s-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />