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Daterun 7/26/2004 10:30:11AI SAN JOAQUIN COUNTY ENVIRONMENTAL HE#H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/26/ 4 <br /> Record Selection Criteria: Facility ID FA0014865 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011871 New Owner ID <br /> Owner Name CALIFORNIA NATURAL PRODUCTS <br /> Owner DBA CALIFORNIA NATURAL PRODUCTS <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1250 E LATHROP RD <br /> LATHROP, CA 95330 <br /> Care of LYNN FORCUM <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014865 <br /> Facility Name CALIFORNIA NATURAL PRODUCTS <br /> Location 1250 E LATHROP RD <br /> LATHROP, CA 95330 <br /> Phone <br /> Mailing Address 1250 E LATHROP RD <br /> LATHROP, CA 95330 <br /> Care of LYNN FORCUM <br /> Location Code APN: <br /> BOIS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025389 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CALIFORNIA NATURAL PRODUCTS (Circle One) <br /> Account Balance as of 7/26/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inachm <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0521881 EE0000942-MARGARET LAGORIO 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 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 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: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />