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Dale run 6/8/2005 9:48:55AM SAN Jr' 'QUIN COUNTY ENVIRONMENTAL HI TH DEPARTMENT <br /> Run by 5290 Report x5021 <br /> Pagel <br /> Facility Information as of 6/8/2005 <br /> Reccrd Selection Criteria: Facility ID FA0012560 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0009761 New Owner ID <br /> Owner Name SANWA BANK CALIFORNIA >�ney a <br /> Owner DBA FORMER WOOD FIBER PRODUCTSQ CI <br /> Owner Address 601 S FIGUEROA ST W11-4 1 aro R G I RA <br /> LOS ANGELES, CA 90017 <br /> Home Phone 213-896-7149 <br /> WorkBusiness Phone Not Specified _ <br /> Mailing Address 601 S FIGUEROA ST W11-4 <br /> LOS ANGELES, CA 90017 <br /> Care of STAN OLSON <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012560 n ^ ^ <br /> Facility Name FORMER WOOD FIBER PRODUCTS <br /> Location 12686 LOCKE RD <br /> LOCKEFORD, CA 95237 <br /> Phone 213-896-7149 <br /> Mailing Address 601 S FIGUEROA ST W11-4 <br /> LOS ANGELES, CA 90017 <br /> Care of SANWA BANK CALIFORNIA <br /> Location Code 99- UNINCORPORATED AREA APN: OS13Z.0 I <br /> BOS District 004 - SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020678 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name LEES&R6-IidE- K OqC{ 6/� IQs �jt e �f (Circle One) <br /> Account Balance as of 6/8/2005: Z7 oD <br /> tl ! (cadaone) <br /> Transfer to ptti�yyiacraa <br /> Prwran enf and Description Record ID Employee ID and Name Status New Owner? Delete <br /> A10 <br /> -RRWWQCB CLEANUP SITE(SLIC) PRO516329 EEDD00997-HARLIN KNOLL Active Y N A I D <br /> LL <br /> are COMPLIANCE ACKNOWLEDGEMEM: I.the undersigned owner,operator or agent of sane,adcnaWeege that all site,aid/or protect specific,PHSIEHD hourly charges assodated with this <br /> facility or activity will be billed to the party identified as the OWNER on this ram. I also certify that all operations will be performed in accordance with all applicable Ordinsce Codes and/or Standards and <br /> State aid/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 Typ'e// Check Number Recery/edlh/,y <br /> REHS: lam- Date / / Account out: lif'J Date I,JLI OS <br /> COMMENTS: <br /> \\phs-ehsgl-nt\appslenvisions4eporls\5021.rpt <br />