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Dale tin 1/6/2009 1:52:09PM SAN 'JO TIN COUNTY ENVIRONMENTAL HEA 'DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 1/6/2009 <br /> Record Selection Criteria: Facility ID FA0000478 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) j <br /> OWNER FILE INFORMATION SSN I Fed Tax ID 11 <br /> Owner ID OW 0000394 New Owner ID <br /> Owner Name HANOT FOUNDATION INC <br /> Owner DBA HANOT FOUNDATION <br /> t Owner Address PO BOX 950 i <br /> LOCKEFORD, CA 95237 r <br /> Home Phone 209-334-6454 <br /> Work/Business Phone 209-334-6454 � <br /> Mailing Address PO BOX 950 l <br /> i <br /> LOCKEFORD, CA 95237 <br /> Care of ROBERT S LONCZAK <br /> I 1 <br /> FACUTY-FILEdNFORMATION <br /> Facility ID FA0000478 <br /> Facility Name HANOT FOUNDATION INC <br /> Location 14373 E SARGENT RD } <br /> LODI, CA 95240 <br /> Phone 209-334-6454 <br /> Mailing Address PO BOX 950 <br /> LOCKEFORD, CA 95237 <br /> Care ofNICHOLAS'CURTIN V ct.�-f e C:Lfes <br /> Location Code 99- UNINCORPORATED i All Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 05303035 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION { <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000477 New Account tD: : i <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name HANOT FOUNDATION INC (Circle One) <br /> Account-Balance as-of 11.612009:. $0.00 = 1 <br /> (ClydsOne) l <br /> Transferto <br /> Programm <br /> /Elearr and Description Reokrd ID Employee ID and Name Status New Owner? Delete <br /> I <br /> 4242-WASTE WATER TX PLANT PR0420071 EE0005366-LISA MEDINA Active Y N A I D j <br /> 4621-15-24 SERVICE CONNECTIONS(CWS) WA0461276 EE0005838-ADRIENNE ELLSAESSEFActive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly Charges associated with this 1 <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 ail applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. , <br /> i <br /> I <br />{ APPLICANTS SIGNATURE: N Date <br /> Program Records to be TRANSFE ED: '$20.00= Amount Paid Date I / <br />#. Water System to be TRANSFERED: `$372.00= Amount Paid Date 1 I <br /> Payment T eak Ember Received by <br /> REH Date 1 1 0 CfAccount out: G Date _/ �2 / 1 f <br /> COMMENTS: <br /> II <br /> 1 <br />