Laserfiche WebLink
Date run 7/26/2004 10:20:58AI SAN JUIN COUNTY ENVIRONMENTAL HESH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/26/2004 <br /> Record Selection Criteria: Facility ID FA0005565 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0004390 New Owner ID <br /> Owner Name MCMANNIS, PAUL <br /> Owner DBA BROWNS LAKE RANCH <br /> Owner Address 339 INDUSTRIAL AVE <br /> RIPON, CA 95366 <br /> Home Phone 209-599-6145 <br /> Work/Business Phone Not Specified <br /> Mailing Address 339 INDUSTRIAL AVE <br /> RIPON, CA 95366 <br /> Care of BROWNS LAKE RANCH <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0005565 <br /> Facility Name BROWNS LAKE RANCH <br /> Location 18700 E RIVER RD <br /> RIPON, CA 95366 <br /> Phone 209-599-6145 <br /> Mailing Address 339 INDUSTRIAL AVE <br /> RIPON, CA 95366 <br /> Care of BROWNS LAKE RANCH <br /> Location Code 05- RIPON APN: <br /> BOS District 005- ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0006181 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name BROWNS LAKE RANCH (Circle One) <br /> Account Balance as of 7/26/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2333-FARM UST#1 FACILITY PRO502762 EE0007289-ALISON YOUNGBLOOD Inactive 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 specific,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 />