Laserfiche WebLink
Date run 4/25/2014 1 45:04PR SAN JOWIN COUNTY ENVIRONMENTAL HEADEPARTMENT Report#5021 <br /> Run by & Pagel <br /> Facility Information as of 4/25/2014 <br /> Record Selection Criteria: Facility ID FA0018758 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) 11-Z'5 -1,4 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID : <br /> Owner ID OW0015425 New Owner ID <br /> Owner Name PETER KATZAKIAN <br /> Owner DBA AVANTI NUT <br /> Owner Address 12022 E COMSTOCK RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-479-3865 <br /> Mailing Address 12022 E COMSTOCK RD <br /> STOCKTON, CA 95215 <br /> Care of GCS ID�1,,,rr��`�" �5 <br /> FACILITY FILE INFORMATION '--� <br /> Facility ID/CERS ID FA0018758 - 7 10 26 3 cf <br /> Facility Name AVANTI NUT <br /> Location ^___ . 4)- 00M LA <br /> STOCKTON, CA 95215 <br /> Phone 209-479-3865 x0 <br /> Mailing Address 12022 E COMSTOCK RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 08902052 e- rc.-.. i 4-Le- Ssl - EMai <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0033303 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name PETER KATZAKIAN (Circle one) <br /> Account Balance as of 4/25/2014: $0.00 <br /> (Circle One) <br /> Transfer to ActiveMactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0527674 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531653 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor projed spec,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certly that all operations will be performed in accordance with all applicable Ordinance Codes and'or Standards and State and'or <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 /> PaymentType Check Number 4QG� '1I Receiv <br /> RENS: Datet�y /f. lyl�y Account out: Date <br /> COMMENTS: 1 —7,5— / 1 <br /> ��nb�l CSS k 0mrrjs I� Cez iS ���� ���2n . <br />