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Date run : 10/27/00 10:52:55AM S/&OAQUIN COUNTY PUBLIC HEALTH Sif ICES Report u: 0002 <br /> Run by VDAVIS Facility Information as of 10/27/00 Page u: 1 <br /> Record Selection Criteria: Facility ID FA0003768 <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; =AYLOR, <br /> / /1.tts t New Owner ID <br /> Owner Nam . NI tOwner DBA; URS A-6 <br /> Owner Address; 330 E KETTLEMAN oI I/ <br /> LODI, CA 95240- (T� <br /> Home Phone; 209-334�4(M5D 15 c o.i a <br /> Work/Bussness Phone: 209-334-4985 J, nir <br /> Mailing Address: PO BOX 523 C 0LD � o / <br /> LODI, CA 95240- / <br /> Care of: TAYLOR, ARNIE <br /> V <br /> FACILITY FILE INFORMATION s �� <br /> Facility ID: FA0003768 <br /> Facility Name: TAYLOR TOURS <br /> Location: 330 E KETTLEMAN LN <br /> LODI, CA 95240 <br /> Phone; 209 � /� (� f Zi/1 <br /> Mailing Address: ro-oP>rsra t= <br /> is (Z�F7t—Lxej G43 <br /> LODI, CA 95241-0523 <br /> care of: TAYLOR TOURS <br /> Location Code: 02 - LODI APN; <br /> BOS District: 004-SEIGLOCK, JACK SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORP I �y y n -76' k Y v pQ <br /> Account ID: AR0003347 yb -7((50 7n t Lb V`� <br /> Mail Invoices to; Facility n � <br /> Account Name: TAYLOR TOURS <br /> Account Balance as of 10/27/00: $0.00 r <br /> Nr tt �i7r AGo o D fzl� <br /> Program/Element and Description Reco ����L` `(\ P"ize-=AS G -710 <br /> 2220-SM HW GEN<5 TONSNR PROF p� v J\ <br /> 2381 -UST FACILITY(BEFORE 1/84) PRO: �t t.. ?�. 33' p b CMiaLL$5 A) <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE F PRO! <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO! <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. L <br /> specific,PHS/EHD hourly charges <br /> with foci <br /> nlso terrify rlarall operations wrlbepeejoraledin actorda p,j q`�Y ✓LrR -rQSA1 —r /�,J OOLU--Y7 <br /> Gv-fir, 970 (-I, I(,, �0C_0ii1rQ0 U*3 -71b10a <br /> APPLICANT'S SIGNATURE: Date / T - --—_ - <br /> Program Records to be TRANSFERED: "$0.00= Amount Paid Date_/ / <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date / /_ 33 <br /> Payment Type Check Number Receipt Number Received by <br /> REHS: Date_/ / Account out: Date / / <br /> IO/W7111)- V t,Z)A-L, - P L.OAS O- C*Ge�GL- -?Wt s DLA,-T. &`MEt-t ssA `f ,4-7 <br /> " RID o"-rmLax -roott&S AT A- 0V6 L-04+-rt0rJ A-n/a E(tEYoLb AIAX '7k-a-' -14 is <br /> 1.0.0.69.00n cs Zo-�6 /� <br /> e/L- it-) 8v—s/ <br /> LLA' taD ` -wA'( 1 NP-�'t AC) �i£�4't A/�+v/E 7'Rytz4 � <br />