Laserfiche WebLink
Date run 7/27/2004 10:05:21AI SAN Jr QUIN COUNTY ENVIRONMENTAL HE/ Z H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/27/4 <br /> Record Selection Criteria: Facility ID FA0003883 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW 0002872 New Owner ID <br /> Owner Name GOLDEN GATE FRESH FOODS <br /> Owner DBA VICTOR FINE FOODS <br /> Owner Address PO BOX 147 <br /> LODI, CA 95241 <br /> Home Phone 209-368-5117 <br /> Work/Business Phone 209-368-5117 <br /> Mailing Address PO BOX 147 <br /> LODI, CA 95241 <br /> Care of GOLDEN GATE FRESH FOODS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003883 <br /> Facility Name VICTOR FINE FOODS <br /> Location 18846 N HWY 99 <br /> LODI, CA 95240 <br /> Phone 209-368-5117 <br /> Mailing Address 18846 N HWY 99 <br /> LODI, CA 95240 <br /> Care of VICTOR FINE FOODS <br /> Location Code 99- UNINCORPORATED AREA APN <br /> BOS District 004- SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003471 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name GOLDEN GATE FRESH FOODS (Circle One) <br /> Account Balance as of 7/27/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2381 -UST FACILITY(BEFORE 1/84) PR0231632 EE0003580-MICHELLE LE Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0507515 EE0003580-MICHELLE LE Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Me undersigned owner,operator or agent of same,acknowledge Mat all site,and/or project specific.PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to Me party identified as the OWNER on this form. I also certify Mat all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> Slate and/or Federal Laws. <br /> APPLICANTS 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 /> RENS: Date / / Account out: Date / / <br /> COMMENTS: <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />