Laserfiche WebLink
Date run 10/10/2013 1:59:43P SAN JOA `IN COUNTY ENVIRONMENTAL HEAL' DEPARTMENT Report x5021 <br /> Run by \t/ Pagel <br /> Facility Information as of 10/10/20 <br /> Record Selection Criteria: Facility ID FA0020341 <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 OW0016699 New Owner ID : <br /> Owner Name MARVIS V GATTO /nI AMIC Tc—�c r r�� R€Sro 2 tna fi tyre <br /> Owner DBA CODE 3 CLEANERS <br /> Owner Address 1588 E MARCH LN _ 33-7 KoSEB�IA� P�- • _ <br /> STOCKTON, CA 95210 1 ary/x±i P_ .C,4 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-952-6333 <br /> Mailing Address 1588 E MARCH LN '-15-2-7 Se"I'774 0 r T <br /> STOCKTON, CA 95210 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0020341 10,187,567 <br /> Facility Name CODE 3 CLEANERS <br /> Location 1588 E MARCH LN <br /> STOCKTON, CA 95210 <br /> Phone 209-952-6333 x0 <br /> Mailing Address 1588 E MARCH LNS 2 7 3 auT--H 't3 S•-R- T <br /> STOCKTON, CA 95210 CA 9_5-2-0 C. <br /> Careof 3"i-c0l}E r—\ (7 lZ-t4 <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 09614022 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 AR0036328 New Account ID: <br /> Mail Invoices to Owner Mail invoices to: Owner / Facility / Account <br /> Account Name (Circle One) <br /> Account Balance as of 10/10/2013: $0.00 <br /> (Circle One) <br /> Transfer to Activellnacb e <br /> Progra"Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0535226 EE0006044-LOWELL ALLEN Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO535291 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,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form 1 also candy that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ander <br /> Federal Laws. <br /> APPLICANT'S 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 Received by <br /> RENS: -7� Date L/%n /-Z3 Account out: Date <br /> COMMENTS: <br /> JNSt nffZS IJ A-% TA4-Ks--F Ct-1c1MtCAL.S "' IZc-¢yK-,ayL � <br />