Laserfiche WebLink
Date run 8/18/2014 11:34:38A1 SAN JOIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/18/201 <br /> Record Selection Criteria: Facility ID FA0014457 <br /> Make changeslcorrectlons in RED ink. <br /> INFORMATION CHANGE(date) 8 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0011499 New Owner ID <br /> Owner Name C l� <br /> Owner DBA C- ✓ - � b-���r 41 rA <br /> Owner Address iR13 � <br /> STOCKTON, CA 95209 <br /> Home Phone 209-209"143 <br /> Work/Business Phone Not Specified <br /> Mailing Address 731 E MINER AVE <br /> STOCKTON, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0014457 10184687 <br /> Facility Name -T� <br /> Location 731 E MINER AVE <br /> STOCKTON, CA 95202 <br /> Phone - �h -7 <br /> Mailing Address 731 E MINER AVE <br /> STOCKTON, CA 95202 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 13931021 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024537 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name KHIN, WESTLEYSRUON (Circle One) <br /> Account Balance as of 8/18/2014: $554.50 <br /> (Circle One) <br /> Transfer to Adlve/InaoNe <br /> ProgramlElement and Description Record ID Employee ID and Name StatusN(g�'Q)wner? Delete <br /> 1920-HMBP-Common Materials PR0519315 EE0009817-ROBERT LOPEZ .Inactive' (:Y N I D <br /> 2220-SM HW GEN<5 TONS/YR PRO637097 EE0009488-JEFFREY WONG Inactive Y N """AAA I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO536849 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andvor project specific,PHStEHD hourly charges associated with this facility or, <br /> be billed to the party Identified as Me OWNER on this forth I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andior Standards and State anoVor Federal Laws. <br /> APPLICANTS SIGNATURE: Date _I_/_ <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date_I_I <br /> Payment Ty Check Number Receive <br /> REHS: � .� 1+-Z Date Account out: Date <br /> COMMENTS: <br />