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Date run 12/17/2001 9:48:59AM SA*QUIN COUNTY PUBLIC HEALTH SEIOES Report a: 5023 <br /> Run by Facility Information as of 12/17/2001 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0013339 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) : <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0010479 New Owner ID <br /> Owner Name: SAN JOAQUIN COUNTY- RIGHT OF <br /> Owner DBA: <br /> Owner Address: 1810 E HAZELTON AVE <br /> STOCKTON, CA 95205 <br /> Home Phone: Not Specified r g 3o5� <br /> Work/Business Phone: Not Specified <br /> Mailing Address: 1810 E HAZELTON AVE <br /> STOCKTON, CA 95205 <br /> Care of: <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0013339 �}� <br /> Facility Name: TRIMARK COMMUNITIES <br /> Location: BYRON/W OF W ICKLUND RD <br /> TRACY, CA 95376 <br /> Phone: 209-836-1560 <br /> Mailing Address: 3120 TRACY BLVD <br /> TRACY, CA 95376 <br /> Care of: <br /> Location Code: APN: <br /> BOS District: 005 - BEDFORD, LYNN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0022157 New Account ID: <br /> Mail Invoices to: Account Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name: CONDOR EARTH TECHNOLOGIES (Circle One) <br /> Account Balance as of 1211712001: $-104.40 <br /> (Circle One) <br /> Transfer to Activelinactve <br /> Program/Element an scription Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-EN ON ASSESS PRO517323 EE0000684-MICHAEL INFURNA Active Y N A 1 D <br /> )W. (e o <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSIEHD hourly charges associated with this <br /> facility or 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I 1 <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: *$150.00= Amount Paid Date / 1 <br /> Payment Type Check Number Received by <br /> RENS: Date /Z 1 1 Account out: ,� Date !Z 1 l I 1 O 1 <br /> COMMENTS: <br /> 11Phs-ehsgl-ntlapps\EnvisionslReports15021.rpt <br />