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Date run 10/15/2014 9:26:31A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/15/2014 <br /> Record Selection Chad.: Facility ID FA0020330 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0016691 New Owner ID <br /> Owner Name J & H MARINE <br /> Owner DBA <br /> Owner Address 2040 SAN ESTEBAN CIR <br /> ROSEVILLE, CA 95747 <br /> Home Phone 209-992-2958 <br /> Work/Business Phone 209-951-0283 <br /> Mailing Address 2040 SAN ESTEBAN CIR <br /> ROSEVILLE, CA 95747 <br /> Care of KOSTER, ERIC <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0020330 10187555 <br /> Facility Name J & H Marine <br /> Location 401 N SAN JOSE ST <br /> STOCKTON, CA 95203 <br /> Phone 209-951-0283 x <br /> Mailing Address 401 N SAN JOSE ST <br /> STOCKTON, CA 95203 <br /> Care of KOSTER, ERIC <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 13526016 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ERIC KOSTER <br /> Title OWNER <br /> Day Phone 209-951-0283 <br /> Night Phone 209-992-2958 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0036311 New Account ID: <br /> Maillnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name J & H Marine (circle One) <br /> Account Balance as of 10/15/2014: $155.00 'F1 Cecu Z8? <br /> IQ�L r tt� (Circle One) <br /> Transfer to AdiveJinactve <br /> ProgromlElement and Description Record ID Employee ID and Name status New Ownea Delete <br /> 1920-HMBP-Common Materials PR0539537 EE0000006-HAZA SAEED Active Y N A I D <br /> 7770- M HW GEN<5 TONS/YR PRO535168 EE0009488-JEFFREY WONG Active Y N A D <br /> (—Z§31'—AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO535169 EE0009488-JEFFREY WONG —,Aaq,� Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0535170 Inactiv( Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andot project specific,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified!as Me OWNER on this form I also certify that all operations will be performed in accordance wide all applicable Ordinance Codes andor Standards and State ander <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date / I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I ! <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Re v y <br /> REHS: Date 4!:� Account out: Date <br /> COMMENTS: <br /> ( c-(o 132- a <br /> �faoo136-53 <br />