Laserfiche WebLink
08/11/2009 08:25 209464013 ENVIRONMENTAL HEALTH PAGE 01/01 <br /> Dne con 9/112009 8:2TWAh SAN <br /> J 1N COUNTY ENVIRONMENTAL HEALT? ARTMENT ReOP"ter <br /> Run W Paact <br /> Facility Information as of 8/1112009 <br /> Recon]3ee010n GOIWA'. redtlry i0 FAD019849 <br /> Make changeslcorreotions in RED Ink. <br /> 1LIol' INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(data) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID <br /> Owner lD OW0016282 New Owner ID <br /> Owner Nome FELICIANO,ANGEL M <br /> Owner DBA ANGEL'S MARBLE <br /> Owner Address 2211 JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Home Phone 209-463-8265 <br /> Work[Busmes .Phone Not SPecfied FFl/`9 JOAnrr1Ar <br /> Mallin Address PO BOX 5368 tMER?� U(jam <br /> 9 �ERIn�S <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019849 <br /> Facility Name ANGEL'S MARBLE <br /> Location 1580 REPORT AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-463-8265 <br /> Mailing Address PO BOX 5368 <br /> STOCKTON,CA 95205 <br /> Care of FELICIANO,ANGEL M <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BDS District 001 -VILLAPUDUA Fax <br /> APN 14315027 EI : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> contact Name FELICIANO,ANGEL M <br /> Title <br /> Day Phone 209-463-8265 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> NewAccountlD: <br /> Account 10 AR0035345 '. <br /> Mail Invoices to: Owner f Facility I Account <br /> Mail Invoices to Facility <br /> (Clrcb one! <br /> Account Nome ANGEL'S MARBLE <br /> Account Balance as of 8/1112009! $0.00 fclydaoe") <br /> irnekr ro Adioiimdve <br /> PmererNElerneM and Dr Obw Re.,d 10 Empbyee nD and Nano SnaNt New OWneri Wort <br /> 2220-SM HW GEN<5 TONS/YR <br /> PRO530479 E E000940B.JEFFREY WONG Active Y N A 1 D <br /> Vftft, <br /> HO <br /> BILLING <br /> w adNar pea 1lha p?r mea n rneft iei rorinr.lI IA n�t pQOM 1epe�non we bg p ft"imee M ar t,nftrr oiI Mh ep 30PA�le Orrrhmine CoEssAaNt"s�aNe ma <br /> SIWn xMor Ferlera Lewd. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: _'$20.00= Amount Paid Date <br /> Water Syslam to be TRANSFERED: "$372.00= Amount Paid Date <br /> Check Number Received by <br /> Payment Type r r Account out: Date,/�/ <br /> REHS: Dale�--�— <br /> COMMENTS: <br /> Ne"nv\envisiomrt9orts'L5021.rpt <br />