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Date run' 2/20/2013 11:12:06AI SAN JO UIN COUNTY ENVIRONMENTAL HEAI —4 DEPARTMENT Report#5021 <br /> Run by `i Pagel <br /> Facility Information as of 2/20/2075 <br /> Record Selection Criteria: 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 1660 LINCOLN ST STE 1800 ( D7> <br /> DENVER, CO 802643103 DRm <br /> Home Phone Not Specified <br /> Work/Business Phone 303-298-1900 <br /> Mailing Address 1660 LINCOLN ST STE#1800 oZ.1 40 15 =.V4tJ8fflt 1;7— ST�F/DO <br /> Care of DENVER, CO 802643103 6 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010407 <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 1660 LINCOLN ST STE#1800 a14io .S T✓A hf PF S7" 57-E Ito <br /> DENVER, CO *G2e431fi3-- <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 005-ORNELLAS, LEROY Fax <br /> APN 20911010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <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 / Account <br /> Account Name ENCON PACIFIC LLC (Circle One) <br /> Account Balance as of 2/20/2013: $425.00 <br /> (Circle One) <br /> Transfer to Active(Inadve <br /> P raMElement and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 1921A HMBP-Regular-Primary Location PRO520336 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 4-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512695 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0510407 EEOOO0000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHrPR0532908 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project speck,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identfiad as the OWNER on this fort I also certify 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 Rece' dby <br /> RENS: Date / / Acwunt out: Date -5/�� <br /> COMMENTS: <br />