BILLING - Laserfiche WebLink

Home Browse Search

Date ruo* 6/2/2015 2:46:39PM SAN JC UIN COUNTY ENVIRONMENTAL HEA I DEPARTMENT Report#5021 Run by Paget Facility Information as of 6/2/2015 Record Selection Criteria: Facility ID FA0009247 OWNER FILE INFORMATION Number of facilities for this owner : 1 Owner ID OW0007247 Case Number: H02373 Owner Name David Garcia Owner DBA B&H TRANSMISSION AUTO CARE Owner Address 3422 E MINER AVE 3422 E. Miner STOCKTON, CA 95205 Home Phone 209-323-5350 Work/Business Phone 209-416-7536 Mailing Address 3422 e miner Status Stockton, CA 95205 Care of GARCIA, DAVID FACILITY FILE INFORMATION Facility ID / CERS ID FA0009247 10182543 Facility Name B&H TRANSMISSION AND AUTO CARE Location 3422 E MINER AVE STOCKTON, CA 95205 Phone 209-323-5350 x Mailing Address 3422 E. Miner Stockton, CA Care of David Garcia Location Code Record ID BOS District Status APN 14339009 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name GARCIA VID Title OW Day Phone -323-5350 Night Phone 209-416-7536 ACCOUNTS RECEIVABLE FILE INFORMATION Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN /Fed Tax ID New Owner ID : So I 60 14)ood L h Wired VP Gid Alt Phone Fax EMail: Account ID AR00162 7 Mail Invoices to Accwrt / L Mail Invoices to: Account Name avid Garcia Account Balance as of 6/2/2015: $1,231.50 New Account ID: : Owner / Facility / Account (Circle One) APPLICANT'S SIGNATURE: —f '�� — Alu( .�-P— Date Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received by EHD Staff: Date l I Account out: V' Date COMMENTS: Invoice #: (Circle One) Transfer to Active/Inactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1920 - HMBP-Common Materials PRO521188 EE0000006 - HAZA SAEED Active Y N A I D 2220 - SM HW GEN <5 TONS/YR PRO513723 EE0000027 - CINDY VO Active Y N A I D 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511535 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509247 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D 3122 - STORMWATER INSPECTION - AUTO SHOP PR0529446 EE0009488 - JEFFREY WONG Inactive Y N A I D ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0533008 Inactive Y N A I D 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 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 Stale and/or Federal Laws. APPLICANT'S SIGNATURE: —f '�� — Alu( .�-P— Date Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received by EHD Staff: Date l I Account out: V' Date COMMENTS: Invoice #: