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Dale un4/2;2013 2:19:08PM SAN JOA,..eIN COUNTY ENVIRONMENTAL HEAL',.DEPARTMENT Report e5021 <br /> Run by Pagel <br /> Facility Information as of 4/2/2013 <br /> Record Selection Cdters: Facility ID FA0010407 <br /> Make changes/corrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008407 Case Number: H08030 New Owner ID <br /> Owner Name ENCON PACIFIC LLC <br /> Owner DBA CONCRETE PRODUCTS OF NORTHERN <br /> Owner Address 2140 S IVANHOE ST STE 100 <br /> DENVER, CO 80222-5749 <br /> Home Phone Not Specified <br /> Work/Business Phone 303-298-1900 <br /> Mailing Address 2140 S IVANHOE ST STE 100 <br /> DENVER, CO 80222-5749 . <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0010407 10,183,527 <br /> Facility Name CONCRETE PRODUCTS OF NO CA <br /> Location 26901 HANSEN RD <br /> TRACY, CA 95376 <br /> Phone 209-836-3125 x0 <br /> Mailing Address 2140 S IVAN HOE ST STE 100 <br /> DENVER, CO 80222-5749 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> SOS District 005 -ORNELLAS, LEROY Fax <br /> APN 20911010 h EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION-�V <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017407 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name ENCON PACIFIC LLC (Circle One) <br /> Account Balance as of 4/2/2013: $425.00 <br /> (Circle One) <br /> Transfer to AcUvdlnacNe <br /> PrograrvElement and Descilption Record ID Employes ID and Name Status New Owned Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520336 EE0002474-MICHAEL PARISSI Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512695 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0510407 EE0000000-HAZ MAT SJC CES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PRO532908 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site.andor project specific,PHS/EHD hourly charges assodated with this reality <br /> or activity will be billed to Uw party Ident,fied as the OWNER on this form I also cMify that all operations will be performed in accordance with all applicable Ordinance Codes andor 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 Type Check Number Receiv <br /> REHS: Date ! / Account out: Date l l I <br /> COMMENTS: <br />