BILLING - Laserfiche WebLink

Home Browse Search

Date run 11/13/2013 9:15:02A SAN JO, JIN COUNTY ENVIRONMENTAL HEAT DEPARTMENT Report#5021 Run by /1 Pagel Facility Information as of 11/13/2013 Record Selection Criteria: Facility ID FA0003681 Make changes/corrections in RED ink. INFORMATION CHANGE(date) It OWNERSHIP CHANGE(date) OWNER FILE INFORMATION SSN/Fed Tax ID Owner ID OW0002749 New Owner 10 Owner Name CALIFORNIA CAR WASH Owner DBA Owner Address 3434 E HAMMER LN STOCKTON, CA 95212 Home Phone 209-957-9274 Work/Business Phone 209-956-4040 Mailing Address 3434 E HAMMER LANE STOCKTON, CA 95212 Care of BUSCAGLIA, CHRISTOPHER J FACILITY FILE INFORMATION Facility lD/CERS ID FA0003681 10,181,303 Facility Name ZOOM CAR WASH Location 3434 E HAMMER LN STOCKTON, CA 95212 Phone 209-956-4040 Mailing Address 3434 E HAMMER LANE STOCKTON, CA 95212 Care of BUSCAGLIA, CHRISTOPHER J Location Code 01 -STOCKTON Alt Phone BOS District 002 - RUHSTALLER, LARRY Fax APN 12802011 EMail: EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name CHRISTOPHER J BUSCAGLIA Title GENERAL MANAGER Day Phone 209-956-4040 Night Phone 209-483-0382 ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0003259 New Account ID: Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account Account Name CALIFORNIA CAR WASH (Circle One) Account Balance as of 11/13/2013: $0.00 (Circle One) Transfer to Activelmicive Progra"Element and Description Record ID Employee ID and Name Status New Owner? Delete 1921 -HMBP-Reqular-Primary Location PR0519965 EE0006044-LOWELL ALLEN Active Y N A I D 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512214 EE0000000-HAZ MAT SJC OES Inactive Y N A I D 2229-GEN 50<250 TONS PERMIT PR0517884 EE0004636-GARRETT BACKUS Active Y N A I D UST STATE SURCHARGE FEE PR0508313 EE0004636-GARRETT BACKUS Inactive Y N A I D EXEMPT TANK FACILITY PRO528077 EE0004636-GARRETT BACKUS Active,l Y N A-C-p, D 2361 -UST FACILITY PR0232398 EE0004636-GARRETT BACKUS Active Y N A I D 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0507399 EE0004636-GARRETT BACKUS Inactive Y N A I D ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531936 Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSrEHD hourly charges associated with this facility or activity will be billed to Ne party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ander Fedeml Laws. �zV� 1A 15113 PEc ,<3 31 PRD5381&v ' APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: `$25.00= Amount Paid Date / / Water System to be TRANSFERED: Amount Paid Date Payment Type C eck Number Race REHS: Date /�/ _ Account out: - Date /L )/o �/ COMMENT •A 4v,., TrrV ] An Jy FLI Ift1./ 2X83