Laserfiche WebLink
Date run 811512014 10:56:28AI SAN JOWIN COUNTY ENVIRONMENTAL HEA1110 DEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 8/15/2014 <br /> Record Selection Criteria: Facility ID FA0022524 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSKI Fed Tax ID <br /> Owner ID OW0020052 New Owner ID <br /> Owner Name W.W. Grainger, Inc. <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 800-994-2336 <br /> Mailing Address 100 Grainger PKWY <br /> Lake Forest, IL 60045 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0022524 10482586 <br /> Facility Name W.W. Grainger, Inc. <br /> Location 2501 Stagecoach Rd <br /> Stockton, CA 95215 <br /> Phone 209-466-2036 x <br /> Mailing Address 100 Grainger PKWY <br /> Lake Forest, IL 60045 <br /> Care of W.W. Grainger, Inc. <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0041204 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility 1 Account <br /> Account Name W.W. Grainger, Inc. (Circle One) <br /> Account Balance as of 8/15/2014: $0.00 <br /> (Circle One) <br /> Transfer to Activelinactve <br /> ProgranvElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0539407 EE0009817-ROBERT LOPEZ 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,PHSlEHD hourly charges associated with this facility <br /> or activity wiii be billed to the party identified as the OWNER on this form. I also certify that aiE 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 1 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I I <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Receo <br /> RENS: Date_ 1 1�_! L1 Account out: Date 1 1 <br /> COMMENTS: !r� <br /> •i ICS VAI t Loot" 'rr PA-0'&12-pCW\ V J A- <br />