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Date ran 5/16/2005 2:59:15PR SAN JOIN COUNTY ENVIRONMENTAL HEAVDEPARTMENT Report#5021 <br /> Run by 5290 Pagel <br /> Facility Information as of 5/16/20 o <br /> Record Selection Criteria: Facility ID FA0016100 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008378 Case Number: H07922 New Owner ID <br /> Owner Name LATHROP, CITY OF <br /> Owner DBA LATHROP CITY OF PUBLIC WORKS W <br /> Owner Address 16775 HOWLAND <br /> LATHROP, CA 95330 <br /> r4/f Hem€PFone 209-858-286.Q <br /> I ork/BusinessPhone Not-,QPeeAe <br /> Mailing Address 16775 HOWLAND RD ['�7i✓b <br /> LATHROP, CA 95330 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016100 <br /> Facility Name U(� <br /> Location zvor ^' o <br /> ^SESMANT-HEY RD <br /> r � <br /> LA�F3 PCA 95330 / / 00 tyO o <br /> Phone <br /> Mailing Address 16775 HOWLAND RD `�£ /�1r37Q <br /> LATHROP, CA 95330 <br /> Care of LATHROP CITY <br /> Location Code APN: <br /> BOIS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0028117 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name KLEINFELDER-"� (ClroleOne) <br /> Account Balance as of 5/16/2005: $465.00 <br /> (Circle One) <br /> Transfer o Active/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 2965-WATER QUALITY SITE PROJECT PR0523929 EE0000684-MICHAEL INFURNA Active 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 project specific,PHS/EHD 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 ander Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$20.00= Amount Paid Date <br /> Water System t e RA SFERED: '$155.00= Amount Paid Date / / <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />