Laserfiche WebLink
Date run 8/15/2014 10:43:04AI SAN J(*IN COUNTY ENVIRONMENTAL HEA16 DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/15/2014 <br /> Record Selection Criteria: Facility ID FA0022522 <br /> Make changesicorrections 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 OW0020050 New Owner ID <br /> Owner Name Frank D. Mills <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/BusinessPhone 209-631-1491 <br /> Mailing Address 4926 W Turner Rd <br /> Lodi, CA 95242 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0022522 10481851 <br /> Facility Name Turner Road Storage <br /> Location 4926 W Turner Rd <br /> Lodi, CA 95242 <br /> Phone 209-631-1491 x <br /> Mailing Address 4926 West Turner Road <br /> Lodi, CA 95242 <br /> Care of Frank D. Mills <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 AR0041202 New Account ID: <br /> Maillnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name Turner Road Storage (Circle One) <br /> Account Balance as of 8/15/2014: $0.00 <br /> (Circle One) <br /> Transfer to Activennaclve <br /> PrograndElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO539405 EE0008709-JAMIE DE LA ROSA Active 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,PHSrEHD 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 Type Check Number Receiv y <br /> REHS: — Date Account out: Date <br /> COMMENTS: <br /> Cpm N(✓w FAru\-1-rn 4- Pgo&aA-,,.\ v or <br /> [�t \-� 2 CI4kM5 6y 0- lots . ru a5�q� 1 <br />