Laserfiche WebLink
Dale run 12/13/2013 1:07:07P SAN JOA COUNTY ENVIRONMENTAL HEALTI PARTMENT Report#5021 <br /> Run by in ' Facility Information as of 12/13/2013 Pagel <br /> Record Selection Cnleria Facility ID FA0019222 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) 12 (3 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0015531 New Owner ID <br /> Owner Name CITY OF LATHROP <br /> Owner DBA 9 V�jj� <br /> Owner Address 390 TOWNE CENTf�DR <br /> LATHROP, CA 95330 <br /> Home Phone 209-941-7382 <br /> WorlBusinessPhone 209-941-7380 <br /> Mailing Address 390 TOWNE CENTRE DR <br /> LATHROP, CA 95330 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019222 10187125 <br /> Facility Name LATHROP STONEBRIDGE STORM DRAIN S <br /> Location 105 TRAVERTINE <br /> LATHROP, CA 95330 <br /> Phone 209-941-7200 <br /> Mailing Address 390 TOWNE CENTER DR <br /> LATHROP, CA 95330 <br /> Care of CITY OF LATHROP <br /> Location Code 0-7 Alt Phone <br /> I District 003 Fax <br /> Al 19671057 EMail: Drt t @ 1 tp rU/J . 0 .US <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name 1A 1 h_�tj 4 I Q <br /> Title 14 4 1 v 2ngnu —r D 2 d /a u s L <br /> Day PhoneIT <br /> Night Phone (� <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034203 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name LATHROP STONEBRIDGE STORM DRAIN STA (Circle One) <br /> Account Balance as of 12/13/2013: $0.00 <br /> (Circle One) <br /> Transferlo Acbve/Inal <br /> Program/Element and Description Record ID Employee ID and Name Stal New Omer? Delete <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO528593 EE0002646-THUY TRAN Active,I Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project specific,PHS/EHD hourly charges associated with this facility <br /> 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 andor Standards and State andor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Tye Check Number c, Recei y <br /> REHS: < U� �/(,LC. Date 1 L Il-- Account out: Date/ Z13— <br /> COMMENTS: <br /> PI ¢�rc App P � 1126 — fie_ PtNVL . <br />