Laserfiche WebLink
f _ <br /> Date run 6/21/01 3:35:33PM SAN' `AQUIN COUNTY PUBLIC HEALTH SEF LES Report #: 5023 <br /> Run by Facility Information as of 6/21/01 �Id Page #. 1 <br /> Record Selection Criteria: Facility ID FA0004093 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0002669 New Owner ID <br /> Owner Name: WASHINGTON MUTUAL <br /> Owner DBA: <br /> Owner Address: 17877 VON KARMAN 3RD FLOOR <br /> IRVINE, CA 92714 <br /> Home Phone: 949-833-4665 <br /> Work/Business Phone: Not Specified <br /> Mailing Address: 17877 VON KARMAN 3RD FLOOR <br /> IRVINE, CA 92714 <br /> Care of: WASHINGTON MUTUAL <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0004093 <br /> Facility Name: LIGHTHOUSE SCHOOL <br /> Location: 222 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Phone: 209-546-2434 <br /> Mailing Address: 17877 VON KARMAN 3RD FLOOR <br /> IRVINE, CA 92714 <br /> Care of: WASHINGTON MUTUAL <br /> Location Code: 01 - STOCKTON APN: 139-100-19-2 <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0003753 New Account ID: <br /> Mail Invoices to: Account Mail Invoices to: Owner/Facility/Account <br /> Account Name: WASHINGTON MUTUAL (Circle One) <br /> Account Balance as of 6/21/01: $0.00 <br /> (Circle" ne) <br /> Transfer to Active/lnact" <br /> Program/Element and Description Record ID Employee ID and Name ttatu/' New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PR0009146 EE0000684-MICHAEL INFURNA A tv e Y N A U1 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 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 Credit Card Number Received by <br /> `— 4.4 U Date�/ ,.W / O <br /> REHS: .YA� � Date 5� /� / � Account out: <br /> COMMENTS: U <br /> �t <br /> I <br /> \\PHS-EHSQL-NT\APPS\Envisions\Client Access\ENVISION\REPO <br />