Laserfiche WebLink
Date run 5/3/2017 7:59:24AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 5/3/2017 <br />Record Selection Criteria: Facility ID FA0016433 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />Owner ID <br />OW0013305 <br />Owner Name <br />_ <br />Owner DBA <br />2908 Bozzano Rd <br />OwnerAddress <br />2908 BOZZANO RD <br />Phone <br />STOCKTON, CA 95215 <br />Home Phone <br />209-931-4125 <br />Work/Business Phone <br />989_224-4117 <br />Mailing Address <br />3055 W M-21 <br />Location Code <br />SAINT JOHNS, MI 48879 <br />Care of <br />nnl;I. l <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0016433 10478575 <br />Facility Name <br />_ S <br />Location <br />2908 Bozzano Rd <br />Inactive Y N <br />Stockton, CA 95215 <br />Phone <br />209-931-4125 x <br />Mailing Address <br />2908 BOZZANO RD <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned <br />STOCKTON, CA 95215 <br />Care of <br />with this facility <br />Location Code <br />01-STOCKTON <br />Bos District <br />002 - MILLER, KATHERINE <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID <br />� arcki <br />-Toedi 6 Gn I DUS <br />aro I I of Lu <br />—VT <br />AWO <br />01 1.1 l <br />Alt PWone <br />Fax <br />EMail : <br />Account ID AR0028909 New Account ID: : <br />Mail Invoices to Account p Mail Invoices to: Owner / Facility <br />Account Name ^^r'^ r MITI I F I I(]I Ilrl CCl?Ttl 1��^^ A r� I uO (Circle One) <br />/ rvr�v GCL�T 14CI�TCTt I-ILILLI\V V 11`//11 (J ("�T <br />Account Balance as of 5/3/2017: $0.00 1 <br />Program/Element and Description <br />Record ID Employee ID and Name <br />Account <br />(Circle One) <br />Transferto Active/Inactve <br />Status New Owner? Delete <br />1921 - HMBP-Reqular-Primary Location <br />PR0537901 EE0008709 - JAMIE LIMA <br />Active Y N <br />A I D <br />2221 - USED OIL ONLY - <5 TONS/YR <br />PR0537738 EE0009488 - JEFFREY WONG <br />Inactive Y N <br />A I D <br />4740 - WASTE TIRE SITE - EXEMPT <br />PR0524503 EE0004045 - TED TASIOPOULOS <br />Inactive Y N <br />A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned <br />owner, operator or agent of same, acknowledge that all site, and/or project specific, <br />PHS/EHD hourly charges associated <br />with this facility <br />or activity will be billed to the party identified as the OWNER on this <br />form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Tye \ Check Number Received b <br />EHD Staff: \ YY\Z�— Date —9 /2—/17 Account out: Date /'_/47 <br />COMMENTS: <br />&w\w 1 t �� �� Invoice #: <br />