Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
Date run 10/1512015 4:26:51P SAN J O UIN COUNTY ENVIRONMENTAL HE* DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/15/2015 <br /> Record Selection Criteria: Facility ID FA0010330 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN 1 Fed Tax ID <br /> Owner ID OW0008330 Case Number: H07768 New Owner ID <br /> Owner Name Richard Kamper <br /> Owner DBA KAMPER FAB INC <br /> OwnerAddress 20107 N RIPON RD _ <br /> RIPON, CA 95366 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-599-7137 <br /> Mailing Address P.O. box 177 <br /> Ripon, CA 95366 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010330 10401217 <br /> Facility Name Kamper Fabrication Inc <br /> Location 20107 S NORTH RIPON RD <br /> Ripon, CA 95366 <br /> Phone 209-599-7137 x <br /> Mailing Address P.O. Box 177 <br /> Ripon, CA 95366 <br /> Care of Richard Kamper <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 245-160-13 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 AR0017330 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility / Account <br /> Account Name Kamper Fabrication Inc (Circle one) <br /> Account Balance as of 10/15/2015: $0.00 <br /> (Circle One) <br /> Transfer to Activefinactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520271 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONSIYR PRO514285 EE0009001 -ELENA MANZO Active Y N A 1 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512618 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0510330 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0533533 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will he 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 andfbr Standards and State ander <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! 1 <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date / 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> EHD Staff: Date 1 1 Account out: Date 1 1 <br /> COMMENTS: <br /> Invoice#: <br />