BILLING - Laserfiche WebLink

Home Browse Search

Date run 10/27/2015 11:40:28/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 Run by Pagel Facility Information as of 10/27/2015 Record Selection Criteria: Facility ID FA0009816 OWNER FILE INFORMATION Number of facilities for this owner: 2 Owner ID OW0007115 Owner Name SOLER, LEWYN Owner DBA PRODUCTION CAR CARE PROD (WHSE Owner Address 1000 E CHANNEL ST Status STOCKTON, CA 95205 Home Phone Not Specified Work/Business Phone 209-610-9850 Mailing Address 1000 E CHANNEL ST 2220 - SM HW GEN <5 TONS/YR STOCKTON, CA 95205 Care of Active FACILITY FILE INFORMATION Facility ID / CERS ID FA0009816 10182931 Facility Name PRODUCTION CAR CARE PROD Location 2000 SANGUINETTI LN N STOCKTON, CA 95205 Phone 209467-0823 x0 Mailing Address 1000 E CHANNEL ST STOCKTON, CA 95205 Care of LEWYN BOLER Location Code 99 - UNINCORPORATED,4 BOS District 002 - MILLER, KATHERINE APN 11910012 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Lewyn Boler Title Owner Day Phone 209-610-9850 Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0016816 Mail Invoices to Owner Account Name BOLER, LEWYN Account Balance as of 10/27/2015: $3,148.50 Make changes/corrections in RED ink. 11 INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN /Fed Tax ID New Owner ID : Ft V AIT Alt Phone Fax EMail: New Account ID: : Mail Invoices to: Owner / Facility / Account (Circle One) (Circle One) (fes Active/Inactve VY.Y Delete ` A A D A I D A I D A I D A I D 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 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 Ordinance Codes and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: * $25.00 = Amount Paid Date Transfer to Program/Element and Description Record ID Employee ID and Name Status New Owner? 1921 - HMBP-Regular-Primary Location PR0519888 EE0000006 - HAZA SAEED Active Y N 2220 - SM HW GEN <5 TONS/YR PR0537959 EE0000027 - CINDY VO Active Y N 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512104 EE0000000 - HAZ MAT SJC OES Inactive Y N 2226 - CalARP PROGRAM PR0514679 EE0000000 - HAZ MAT SJC OES Inactive Y N 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509816 EE0000000 - HAZ MAT SJC OES Inactive Y N ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0532371 Inactive Y N (Circle One) (fes Active/Inactve VY.Y Delete ` A A D A I D A I D A I D A I D 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 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 Ordinance Codes and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: * $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received by /0/ 2l? 15, EHD Staff: i!1 rs Date 10 IS Account out: Date / COMMENTS: Invoice #: ��cw.��c laJ•s �� .rce, �c oK— �`'��. �, ce,�o �,.bla. ��cCSho` � ��w.rb,�:� .