Laserfiche WebLink
Date run 1/;/20 3:09:43Ph SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Run by Report N5021 <br /> Facility Information as of 1/31/2017 Pagel <br /> Retard Selection Facility ID FA0011046 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) J <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 <br /> SSN/Fed Tax ID <br /> Owner ID OW0009045 Case Number: H09209 New Owner ID <br /> Owner Name HOUSING AUTHORITY OF SJ COUNTY <br /> owner DBA HOUSING AUTHORITY OF SJ COUNTY <br /> OwnerAddress 741 S BELLEVIEW ST <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-460-5063 <br /> Mailing Address 421 S EI Dorado St. <br /> STOCKTON, CA 95203 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0011046 10184061 <br /> Facility Name SIERRA VISTA HOMES HACSJ <br /> Location 2424 S BELLEVIEW ST <br /> STOCKTON, CA 95206 <br /> Phone 209-670-4757 x <br /> Mailing Address 421 S EI Dorado St <br /> Stockton, CA 95203 <br /> Care of Fabiola Davis <br /> Location Code 01 -STOCKTON Alt Phone <br /> Bos District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 16927002 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 AR0018046 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SIERRA VISTA HOMES HACSJ (Circle One) <br /> Account Balance as of 1/31/2017: $344.00 <br /> (Circle One) <br /> Tfansferto ActivrAnactve <br /> /eklement and Description Record ID Employee ID and Name Status New Owner1 Delete <br /> BP-Regular-Primary Location PRO520631 EE0009817-ROBERT LOPEZ A Ive N A 1 D <br /> 2220- HW GEN<5 TONSNR PRO514505 EE0000026-CESAR RUVALCABA N/A� I D <br /> -HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513334 EEOOOOOOO-HAZ MAT SJC OES Ina Iv Y N` I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO511046 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0531190 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0534314 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 prgact Specific,PHS HD hourly charges associated with this faulity <br /> or activity will be billed to the party identfied as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State andor <br /> 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 / / <br /> Payment Typ Check Number Received �l <br /> EHO Staff: f Date / /_ Account out: Date / / / I <br /> COMMENTS: <br /> Invoice#: <br /> JX /t o <br /> ge0,, Q�zC) z7 0 t 4"� r 063 e✓de� lZrL1/1 ic,. �J <br />