Laserfiche WebLink
Date nm 7/24/2015 8:55:OOAN SAN JO�JIN COUNTY ENVIRONMENTAL HEA!,j DEPARTMENT Report M5021 <br /> Run by Pagel <br /> Facility Information as of 7/24/2015 <br /> Record Selection Criteria: Facility ID FA0019920 <br /> Make changestcorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> OwnerlD OW0016343 New Owner ID <br /> Owner Name JOSHUA BOYCE <br /> Owner DBA BEDLINER SPECIALIST <br /> Owner Address• <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-747-3011 <br /> Mailing Address 1330 AUTO CENTER DR#A <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019920 10187415 <br /> Facility Name BEDLINER SPECIALIST <br /> Location —`F I F f0i1 L, <br /> LODI, CA 95240 <br /> Phone 209-339-8285 x0 <br /> Mailing Address <br /> LODI, CA 95240 <br /> Care of Joshua Boyce <br /> Location Code 02 - LODI Alt Phone <br /> SOS District 004 -WINN. CHARLES Fax <br /> APN 04931049 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0035499 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name JOSHUA BOYCE (Circe One) <br /> Account Balance as of 7/24/2015: $0.00 <br /> (arch one) <br /> Transfer to Active/Inal <br /> ProgramtElemenl and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 1921 -HMBP-Regular-Primary Location PR0530764 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0536850 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge Chet all site,andior project specific,PHSEHD hourly charges associated with this facility or <br /> be billed to the party identified as the OWNER on this forth I also certify that all operations will be performed in accordance with all applicable Ordinance Codes al Standards and State end'or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date_/ /_ <br /> Water System to be TRANSFERED: Amount Paid Date_/_I_ <br /> Payment Type Check Number Received by <br /> EHD Staff: Date —7 /2—LiAccount out: Data S' <br /> COMMENTS' <br /> Invoice* <br /> A�Oress I ria ��iSc�o s r f� <br /> S 0'f V((X) <br />