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Run by : STAFF <br /> San Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 08/13/99 <br /> Make changes/corrections :in KED pen or pencil: <br /> OWNER FILE INFORMATION <br /> ,INFORMATION CHANGE {date} : <br /> OWNERSHIP CHANGE (-date) : <br /> OWNER ID: 006313 -r New owner ID: 00 . <br /> Owner Name: PRUDENTIAL INSURANCE' CO OF AME <br /> Owner I)BA: DURHAM RANCH i <br /> Owner Address: 7108 N FRESNO ST 400 - <br /> FRESNO, CA 93720 <br /> Home Phone: 209-437-0190 <br /> Soc sec# / Tax ID#: FID22-1211670 <br /> ownership Type: 01 CORPORATION <br /> Mailing Address: 7108 N FRESNO ST 400, <br /> Care ct: PRUDENTIAL INS CO OF:, AMERICA <br /> FRESNO, CA 93720 <br /> FACILITY FILE INFORMATION t <br /> FACILITY ID: 007643 <br /> Facility Name: DURHAM RANCH <br /> Location: 700 W LINNE RD <br /> TRACY 95376 <br /> Phone: 209-437-3242 <br /> I <br /> Mailing Address: 7108 N FRESNO ST STE":40'1 <br /> care of: CAPS <br /> FRESNO, CA 93720 <br /> Location Code: APN; - <br /> ROS District: 005 SIC Code: ' <br /> 'k <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0012837 t. New Account ID: 000 ;J <br /> Mail Invoices to: Facility !� Mail Invoices to: Owner., / Facility / Account <br /> Account Name: DURHAM RANCH % <br /> .(Circle one) <br /> Account Balance as of 08/13/9 9 : $0 . 0 0!. - <br /> (Circle on <br /> Record UST(s) Transfer to Activa / Inactivate <br /> P E--Description ' <br /> ---- ----- --- ID --- ------- -Employee ee -----Status - - Linked new owner? -_ Dele ` <br /> / P P Y 7 <br /> --- -- ----- ---- ---- ----- - -1-------- 1 <br /> 29 1 UGT-CAP PR506469 0684 INFURNA ACTIVE Y N D <br /> IL�I` <br /> --------------- ---- --`_- ---------�----_--------- ------ ----- ---- ----- ------------ <br /> BILLING <br /> --- ----`- ----- ---- ----- ------------BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned:owner,.operator or agent of same, acknowledge that all site and/or. <br /> project specific PHS/EHD hourly charges associated with'-this facility cr.activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that,all operations will be performed-,in accordance with:all applicable SAN JOAQUIN <br /> k- <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: :j Date <br /> -------- --- - ----- ---- ----- ---- -------- ------- ------- --------- ----- - --------- <br /> PR Records to be TRANSFERED: x $20.00 Amount Paid - Date <br /> iter System to be TRANSFERED: -x $150.DD = Amount Paid Date <br /> Payment Type Check # Recvd by <br /> --- ----- ----- ------- -----/!l-1�- - - -=---= --p- -/ - --- ---------- <br /> S or COUNTER SUPV Date/ / B ACCT out: V�� Dated / I /-f UNIT/File: / / f <br /> I <br /> i ;J <br />