Laserfiche WebLink
Date non 2113/20414 11:40:30AI SAN JO UIN COUNTY ENVIRONMENTAL HEAT 'DEPARTMENT Report#5021 <br /> Ran by Pagel <br /> Facility Information as of 2/13/2014 <br /> Recent Selection Criteria: Facility ID FA0017309 <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 OW0014150 New Owner ID <br /> Owner Name COOPER OUT WEST <br /> Owner DBA COOPER OUT WEST <br /> Owner Address 18636 E MILTON RD <br /> LINDEN, CA 96236 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 3+8656-E­N11t_TQN4RD_ -l!)OX <br /> LINDEN, CA 95236 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017309 10,186,251 <br /> Facility Name COOPER OUT WEST <br /> Location 19180 HARROLD <br /> ESCALON, CA 95320 <br /> Phone 209467-1324 <br /> Mailing Address 466z1e-E-WHt-Tef4-RD <br /> LINDEN, CA 95236 <br /> Care of <br /> Location Code Aft Phone <br /> BOS District Fax <br /> APN 24903033 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030191 New Account ID: <br /> Mail Invoices to Ovirner Mail Invoices to: Owner / Facility / Account <br /> Account Name COOPER OUT WEST (Circle One) <br /> Account Balance as of 2/13/2014: $266.00 <br /> (Circle One) <br /> Transfer to Activeflaachre <br /> PaogharrvElement and Description Record to Employee to and Name $law. New Omer? Delete <br /> 1958-HM-Farm Operations PRO525494 Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0529821 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO529820 EE0009001 -ELENA MANZO Activej Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531687 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACo1OW_EDGEMi 1,the undersighad owner,operates or agent of same,sclmowoall that all site,ancVor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as me OWNER on this form. I also amity that all operations will be performed in accordance with all applicable Ordinance Codes anclor Standards and State ardor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: $25.00= Amount Paid— Date I <br /> Water System to be TRANSFERED: Amount Paid— Date <br /> Payment Type Check Number —Rete' by <br /> REHS: Date I AccountDate 2 /AP 71 <br /> COMMENTS 7— <br />