Laserfiche WebLink
Date run 11/20/2018 4:00:19P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 11/20/2018 <br />Record Selection Criteria: Facility ID FA0017033 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0013874 <br />Owner Name <br />EC WATTS <br />Owner DBA <br />EC WATTS <br />OwnerAddress <br />17010 N LOCUST TREE RD <br />Phone <br />LODI, CA 95240 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />17036 N LOCUST TREE RD <br />Location Code <br />LODI, CA 95240 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0017033 10185789 <br />Facility Name <br />EC WATTS <br />Location <br />17010 N LOCUST TREE RD <br />LODI, CA 95240 <br />Phone <br />209-368-8606 <br />Mailing Address <br />17036 N LOCUST TREE RD <br />LODI, CA 95240 <br />Care of <br />Location Code <br />BOS District <br />APN 05112036 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Make changestcorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID <br />1 .` <br />i�A h�t.r 11S ire, <br />niAo� taA t'oiAn�, <br />k1Pxu14J( k eft \ASID(�, <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0029915 <br />Mail Invoices to Owner Mail Invoices to: <br />Account Name EC WATTS <br />Account Balance as of 11/20/2018: $101.00 <br />• •1 <br />New Account I D: : <br />Owner / Facility <br />(Circle One) <br />Account <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1958 - HM -Farm Operations PR0525218 EE0002670 - MUNIAPPA NAIDU Active Y N � I D <br />2220 - SM HW GEN <5 TONS/YR PR0536184 EE0000030 -AARON HANG Inactive Y N A D <br />2830 -AST FAC - SPCC EXEMPT PR0536185 EE0000030 -AARON HANG Inactive Y N A D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI PR0533342 Inactive Y N A 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 State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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 Received by <br />EHD Staff: LhPrC1 �.11 l�CxU Date_ Account out: Date <br />COMMENTS: Invoice ##: �' ! ✓ / <br />