Laserfiche WebLink
Date run 4/20/2015 8:39:07AN SAN JC 'JIN COU ;TY EWIRONMENTAL HEA 'DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 4/20/2015 <br />Record Selection Criteria: Facility ID FA0022846 <br />Make changes/corrections 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 />Owner ID OW0020797 New Owner ID <br />Owner Name Verizon Wireless <br />Owner DBA <br />Owner Address <br />Home Phone Not Specified <br />Work/Business Phone 866-694-2415 <br />Mailing Address 255 Parkshore Drive <br />Folsom, CA 95630 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0022846 10595476 <br />Facility Name <br />Location <br />3535 N EL DORADO ST <br />Stockton, CA 95204 <br />Phone <br />866-694-2415 x <br />Mailing Address <br />255 Parkshore Drive <br />Folsom, CA 95630 <br />Care of <br />Verizon Wireless <br />Location Code <br />BOS District <br />APN <br />115-130-15 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0041912 <br />Mail Invoices to Account <br />Account Name Environmental Compliance <br />Account Balance as of 4/20/2015: $305.00 <br />V«�zon Wirt ess E dopitne,Of <br />he <br />Alt Phone <br />Fax <br />EMail : <br />Mail Invoices to <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transferto Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PR0539966 EE0000006 - HAZA SAEED Active 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 project specific, PHS/EHD hourly charges associated with this facility <br />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 all applicable Ordinance Codes and/or Standards and Stale and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS: <br />$25.00 = <br />Date <br />Date <br />Amount Paid Date <br />_ Amount Paid Date <br />Received by <br />Account out: _6jlb, Date '20 / �5 <br />