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Date run 6/15/2011 4:14:49PN SAN X *JIN COUNTY ENVIRONMENTAL HEADEPARTMENT Report x5021 <br /> Run by Pagel <br /> Facility Information as of 6/15/2011 <br /> Record Selection Criteria: Facility ID FA0009180 <br /> FI ■ Make changes/corrections in RED Ink. <br /> ■Y INFORMATION CHANGE(date) t <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007180 e44umbeF.—k10_7 4� New Owner ID <br /> Owner Name KENST, CLIF t/ <br /> Owner DBA CENTRAL VALL Y FABRICATORS <br /> Owner Address 1700 E PINCHOT ST <br /> STOCKTON, CA 95205 � � _ <br /> Home Phone Not Specified <br /> Work/Business Phone 209-948-6448 <br /> Mailing Address 1700 E PINCHOT ST NOV 7 2011 <br /> STOCKTON, CA 95205 ��1' <br /> Care of J ICE OF EMFR0E,�6Y" <br /> �v �I IVfGE,� <br /> FACILITY FILE INFORMATION r1�• (`�� <br /> Facility ID FA0009180 <br /> Facility Name CENTRAL VALLEY FABRICATORS <br /> Location 1700 E PINCHOT ST <br /> STOCKTON, CA 95205 <br /> Phone 209-948-6448 <br /> Mailing Address 1700 E PINCHOT ST <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 11733029 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 AR0016180 NewAccount ID: <br /> Mail Invoicesto Facility :Tnvo' I . wrier%Facility / A;Acdv <br /> Account Name CENTRAL VALLEY FABRICATORS /11 cimle One) j <br /> Account Balance as of 6115/2011: $0.00 Lyl, 1n�vC C` �1�: S 4 c'.te 1 <br /> Transfer to actve <br /> ProgramlElement and Description Record ID mployee ID and Name Statue New O%,nerl elate <br /> 2220-SM HW GEN<5 TONS/YR PRO518533 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0511468 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO519441 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO509180 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPRO532054 Active Y N A I D <br /> 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 <br /> 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 Ordinate Codes and/or Standards and <br /> 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 ReceivW by <br /> REHS: Date_/ / Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />