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Date run: 5/3/00 9:08:07AM SA f&AQUIN COUNTY PUBLIC HEALTH SEES Report #: 0002 <br /> .tun by SDRISCOL Facility Information as of 5/3/00 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0007440 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0002972 New Owner ID <br /> Owner Name: SPRECKLES DEVELOPMENT CO INC <br /> Owner DBA• <br /> Owner Address: 18800 SPRECKLES RD <br /> MANTECA, CA 95336- <br /> Home Phone: 209-823-3121 <br /> Work/Bussness Phone: 209-823-3121 <br /> Mailing Address: 18800 SPRECKLES RD <br /> MANTECA, CA 95336- <br /> Care of: ,JEFFREY FLEMING <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0007440 <br /> Facility Name: ATHERTON KIRKISPRECKELS <br /> Location: 18800 SPRECKLES RD <br /> MANTECA, CA 95336 <br /> Phone: 209-823-3121 J <br /> Mailing Address: 4502 GEORGETOWN PL#203 OX <br /> STOCKTON, CA 95336- <br /> Care of: MIKE ATHERTON <br /> Location Code: 04-MANTECA APN; <br /> BOS District• SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0011324 New Account ID:: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: ATHERTON KIRK/SPRECKELS (Circle One) <br /> Account Balance as of 5/3/00: $390.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactv <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2950-ENVIRON ASSESS PRO606460 EE0007479-ROWE Active Y N I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: /,the undersigned owner,operator or agent O-same,acknowledge that aft site,and/orproject <br /> specific,PHS/MID hourly charges associated with this facility or activity will be billed to the party Mean red as the BILLING PARTY on thisform. I <br /> also certify that all operations will be performed in accordance with all applicable Oanace Codes an or Standards and State and/or Federal Laws <br /> APPLICANT'S SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number Receipt Number Received by <br /> REHS: Date / / Account out: Z�ADate I / <br /> 1.0.0.89.00 <br />