Laserfiche WebLink
Da,nun '1/25/2014 9:06:08Ak SAN JC UIN COUNTY ENVIRONMENTAL HEA,.s,,lt1 DEPARTMENT Report*5021 <br /> Run by "" Pagel <br /> Facility Information as of 3/25/2014 <br /> Record Selection Criteria: Facility 10 FA0012425 <br /> Make changes/corrections 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 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 10,184,245 ' r,t5t h1255 ncr �U✓l tier <br /> Facility Name ASBURY ENVIRONMENTAL SERVICES <br /> Location 1187 VANDERBILT CIR 2 Of fibl 1. 61C C,,A <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 /> BOS 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 (Circle One) <br /> Account Balance as of 3/25/2014: $5N-4 <br /> (Circle One) <br /> Transfer to Active/Ineclve <br /> ProgranvElement and Description Record ID Employee ID and Name Status New OvmeR Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0520918 EE0002474-MICHAEL PARISSI Active Y N AI D <br /> 2220-SM HW GEN<5 TONS/YR PR0516227 EE0009001 -ELENA MANZO Active Y N A 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 PRO516024 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532500 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor 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 endo,Standards and State endor <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 _ Raceiv <br /> REHS: Q+L Sy, Date Account out: Date <br /> COMMENTS: <br />