Laserfiche WebLink
shut 5/1/2014 3:38:23PM SAN J IN COUNTY ENVIRONMENTAL HEA Report#5021 DEPARTMENT Pagel <br /> in by <br /> Facility Information as of 5/1/2014 <br /> Record Selection Criteria: Facility ID FA0005608 <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 SSN/Fed Tax ID <br /> Owner ID OW0004433 New Owner ID <br /> Owner Name HD Supply Waterworks, LTD <br /> Owner DBA <br /> Owner Address 1625 STOCKTON ST <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 770-852-9000 <br /> Mailing Address 3100 Cumberland Blvd., MS-1226 <br /> Atlanta, GA 30339 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0005608 10,145,903 <br /> Facility Name HD Supply Waterworks Ltd <br /> Location 1625 S Stockton St <br /> Lodi, CA 95240 <br /> Phone 209-333-7698 x <br /> Mailing Address 1625 S Stockton St <br /> Lodi, CA 95240 <br /> Care of ,John Buck <br /> Location Code 02 - LODI Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 062-050-11 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 AR0006241 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name HD Supply Waterworks, LTD (Clrcle One) <br /> Account Balance as of 5/1/2014: $0.00 <br /> (circle one) <br /> Transferlo Active/Inactve <br /> Progr-an✓Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520808 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513694 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511462 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO502895 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509174 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on thisform. lake certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date _/_/ <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to <br /> be T—RANSFE—RED: Amount Paid DatePayme <br /> REHS:ntTyRe�° Y�?cC�— Check Number Receiv G- <br /> t Date�I_L/ Account out: Date <br /> �o c.urn i eca-2 a+ <br /> It�l5 S StociL- tXl - s- �- r1t <br />