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k <br /> Run by : STAFF San Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 10/24/97 r <br /> { Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION € INFORMATION CHANGE (date) : <br /> 'j OWNERSHIP CHANGE (date) : <br /> OWNER ID-. 006128 New Owner ID: 0 0 <br /> Owner Name; PRADA, R I CHARD <br /> Owner DBA: 6 f <br /> owner Address: 1045 MARSH CREEK LANE <br /> MANTECA, CA 95336 E <br /> Home Phone: 209-823-4639 <br /> Soc Sec# / Tax ID#: . <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 25864-F BUSINESS CENTER DR <br /> Care of: SECOR ' <br /> REDLANDS, CA 92374-4515 <br /> k <br /> FACILITY FILE INFORMATION f <br /> FACILITY ID: 007417 <br /> �k <br /> Facility Name: ARCO #YWOP if <br /> Location: 1100 S MAIN ST q <br /> MANTECA 95336 ;€ <br /> Phone: �II <br /> �p <br /> Mailing Address: 25864-F BUSINESS CENTER DR 1 <br /> care of: SECOR <br /> REDLANDS, CA 92374-4515 <br /> �I <br /> Location Code: APN: <br /> BOS District: SIC Code: `) <br /> it <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0011176 New Accou At ID: 000 <br /> Mail Invoices to: Account Mail Invoices to: Owner / Facility / Account <br /> Account Name: SECOR I (Circle one) <br /> Account Balance as of 10/24/97 $0 . 00 i (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> L <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> 2950 ENVIRON ASSESS PR506427 0684 INFURNA INACTIVE t Y N A I D <br /> BILLING 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 activityjwill be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> -------------------------------------------------i---------- - ------------------ - <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid i3 Date / / <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid!t Date / / <br /> Payment Type Check it Recvd by <br /> RENS or COUNTER $UPV: Date / / ACCT out: Date / / UNIT/File: <br /> i <br /> j :� <br />