Laserfiche WebLink
Dat <br /> Run by COUNTY <br /> 3'/11/2014 3:04:02PA SAN J( �JIN COUNTY ENVIRONMENTAL HE/ DEPARTMENT Report#5021 <br /> Run by _- Pagel <br /> Facility Information as of 3/11/2 14 <br /> Record Selection Criteria: Facility ID FA0012425 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0009635 New Owner ID <br /> Owner Name ASBURY ENVIRONMENTAL SERVICES <br /> Owner DBA ASBURY ENVIRONMENTAL SERVICES <br /> Owner Address 1187 VANDERBILT CIR#2 <br /> MANTECA, CA 95337 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-239-5587 <br /> Mailing Address 1187 VANDERBILT CIR#2 <br /> MANTECA, CA 95337 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0012425 10184245 <br /> Facility Name ASBURY ENVIRONMENTAL SERVICES <br /> Location 1187 VANDERBILT CIR 2 <br /> MANTECA, CA 95336 <br /> Phone 209-239-5587 <br /> Mailing Address 1300 S SANTA FE AVE <br /> COMPTON, CA 90221 <br /> care of DOMINO, ROSEMARY <br /> Location Code 04 - MANTECA Alt Phone <br /> BOIS District 005 - ELLIOTT, BOB Fax <br /> APN 22119016 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GONCALVES, RUI <br /> Title 2094817922 <br /> Day Phone 209-481-7922 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020282 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to. Owner / Facility / Account <br /> Account Name ASBURY ENVIRONMENTAL SERVICES (Ctrde One) <br /> Account Balance as of 3/11/2014: $ 0 <br /> (Circle Ogre) <br /> Transfer to Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New OvmeR Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520918 EE0002474-MICHAEL PARISSI Active Y N A D <br /> 2220-SM HW GEN<5 TONS/YR PR0516227 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0516023 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0516024 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532500 Inactive Y N A 1 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 this form. I also certify that all operations will be performed,n accordance with all applicable Ordinance Codes andor Standards and State ands <br /> Federal Lewis <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Re by <br /> REHS: 4014 --D� DateQ�/��/ Account out: Date / / <br /> COMMENTS: <br /> p�P/�U� lr0.CQ VQ � , 6GhH� Q�h �ePQC� Lu� 'Cs$vco� <br />