Laserfiche WebLink
Report # 5023 <br /> : <br /> Date mn, 9/21/01 1:37:13PM SAN�AQUIN COUNTY PUBLIC HEALTH SERVICES Page �. 1 <br /> Run by Facility Information as of 9/21/01 • <br /> Record Selection Criteria: Facility ID FA0013309 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0010450 New Owner ID <br /> Owner Name: GENERAL DYNAMICS OTS (CA) INC <br /> Owner DBA: <br /> Owner Address: 400 ESTUDILLO AVE <br /> SAN LEANDRO, CA 94577 <br /> Home Phone: 510-614-5360 <br /> Work/Business Phone: Not Specified <br /> Mailing Address: 400 ESTUDILLOAVE <br /> SAN LEANDRO, CA 94577 <br /> Care of: <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0013309 <br /> FacilityName: TRACY TEST FACILITY <br /> Location: 32727 CORRAL HOLLOW RD <br /> Phone: <br /> TRACY, CA 95376 1 <br /> Mailing Address:_4865gOMMERCfAL-DR--ST`E-A- P d • C'�oX 5a3s <br /> NICEVILLE, FL 32578 <br /> Care of: <br /> Location Code: APN: <br /> BOS District: 005- BEDFORD, LYNN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0022111 New Account ID: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: TRACY TEST FACILITY (Circle One) <br /> Account Balance as of 9/21/01: $217.50 <br /> (Cimle One) <br /> Transfer to ActNe/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2959-NON NPUSEP HZ SITE PR0517291 EE0000997-HARLIN KNOLL Active Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project speck,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 Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: Date_/ / Account out: Date 1 <br /> COMMENTS: ��•, <br /> 1 � V <br /> 1 " <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt �- <br />