Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
Date run 2/22016 9:15:41AM SAN JOIN COUNTY ENVIRONMENTAL HEAL#EPARTMENT Report 45021 <br /> Run by Pagel <br /> Facility Information as of 2/2/2016 <br /> Record Selection Criteria: Facility ID FA0020078 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN/Fed Tax ID <br /> Owner ID OW0008985 Case Number: H09103 New Owner ID <br /> Owner Name GULLY, VINCE <br /> Owner DBA <br /> OwnerAddress PO BOX 5308 <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-466-3041 <br /> Mailing Address PO BOX 5308 <br /> STOCKTON, CA 95205-0308 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0020078 10187503 <br /> Facility Name GMS WESTERN LIFT INC <br /> Location 2354 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-482-4531 x <br /> Mailing Address PO BOX 5308 <br /> STOCKTON, CA 95205 <br /> Care of GULLY, VINCE <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 15324024 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GULLY, VINCE <br /> Title <br /> Day Phone 209-482-4531 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0035811 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name GMS WESTERN LIFT INC (Circle One) <br /> Account Balance as of 2/2/2016: $0.00 <br /> (Circle One) <br /> Transfer to ActiveAnaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0537268 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0531169 EE0000027-CINDY VO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO534027 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 spec,PHS/EHO hourly charges associated with this facility or t <br /> 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 andor Standards and State and'or 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 /> EHD Staff. Date_/ / Account out: Date <br /> COMMENTS: Invoice#: <br />