Laserfiche WebLink
Date run : 5/9/00 1.1:36:07AM SA QUIN COUNTY PUBLIC HEALTH S -S Report #: 0002 <br /> Run by SDRISCOL Facility Information as of 5/9/00 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0009860 <br /> 1 <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; OW0007860 Case Number: H05669 New OwnerlD <br /> Owner Name; CARL A BLAIN <br /> Owner DBA' <br /> Owner Address: <br /> Home Phone: Not Specified <br /> work/Bussness Phone: 209-334-5303 <br /> Mailing Address: 11900 E LOCKE RD <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0009860 <br /> Facility Name: WOLF MFG INC <br /> Location: 11900 E LOCKE RD <br /> LOCKEFORD, CA 95237 20 <br /> Phone; 209-334-5303 fI �r <br /> Mailing Address: PO BOX 69 O v fT5 ' `•el.- — <br /> �erj <br /> Care of; CARL A BLAIN dYt i <br /> Location Code: 99 - UNINCORPORATED AREA APN; 051-160-04 <br /> BOS District: 004 - SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0016860 New Account ID:: <br /> Mail Invoices to: Account Mail Invoices to; Owner/ Facility /Account <br /> Account Name: WOLF FG INC (Circle One) <br /> Account Balance as of 5/9/00: $110.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inacty <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE F PRO509860 EE0000000-SJC OES Active Y N I <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512148 EE0000000-SJC OES Active Y N <br /> 2220-SM HW GEN<5 TONS/YR PRO514065 EE0006213-PEDRAZA Active Y N I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project <br /> specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the party identf red as the BILLING PARTY on thisjorm. / <br /> also certify that all operations will be performed in accordance with all applicable Ordinate Codes an or Standards and State andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I / <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 Receive by <br /> REHS: Date / I Account out: Date I I <br /> 1.0.0.89.00 <br />