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Date run 11/13/2006 2:32:23P SAN JOWIN COUNTY ENVIRONMENTAL HEADEPARTMENT Repo #5021 <br /> Run by 4006 Pagel <br /> Facility Information as of 11/13/2 <br /> Record Selection Criteria: Facility ID FA0008093 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0006691 New Owner ID <br /> Owner Name CONTINENTAL GRAIN COMPANY <br /> Owner DBA <br /> Owner Address 222 S RIVERSIDE 1100 <br /> CHICAGO, IL 60606 <br /> Home Phone Not Specified <br /> Work/Business Phone 312-207-5100 <br /> Mailing Address 222 S RIVERSIDE STE 1100 <br /> CHICAGO, IL 60606 <br /> Care of MBROWN <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0008093 <br /> Facility Name CONTINENTAL GRAIN CO <br /> Location 9504 S HARLAN RD <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-982-1121 <br /> Mailing Address 222 S RIVERSIDE <br /> CHICAGO, IL 60606 <br /> Care of M BROWN <br /> Location Code 99- UNINCORPORATED AREA APN: <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0015386 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CONTINENTAL GRAIN COMPANY (Circle One) <br /> Account Balance as of 11/13/2006: $0.00 <br /> (Circle One) <br /> ' Transfer to Active/Inadve <br /> Program/Element and Description Retard ID Employee ID and Name Status New Omen Delete <br /> 2960-RWQCB SITE PR0508462 - Active Y N A I D <br /> 6�� 4�4A-tJ <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent ame—,a nowladge that all site,and/or project spec,PHS/EHO 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 /> Stale and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TNSFERED: _*$372.00= Amount � <br /> Paid 5r� Date <br /> Payment Type t/ Check Number .24—13 1. Received by 2.-L- <br /> REHS: Date_/ /_ Account out: Date <br /> COMMENTS: <br /> I f'W tl- 15311 9 <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />