Laserfiche WebLink
Date run 2/1/2013 11:22:35AM SAN JUIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/1/2013 <br /> Record Selection Criteria: Facility ID FA0013655 <br /> Make changeslcorrections in RED ink. n - 1_ '!t <br /> INFORMATION CHANGE(date) L' 7 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0010765 New Owner ID <br /> Owner Name INTEGRATED TRUSS SYSTEMS INC <br /> Owner DBA VILLA TRUSS <br /> Owner Address 1320 E VICTOR <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-333-7117 <br /> Mailing Address 1220 E VICTOR RD <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013655 <br /> Facility Name VILLA TRUSS <br /> Location 1320 E VICTOR <br /> LODI, CA 95240 <br /> Phone 209-333-7117 x0 <br /> Mailing Address 1220 E VISTOR RB <br /> LODI, CA 95240 <br /> Care of <br /> Location Code 02 - LODI Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 04932008 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022812 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name INTEGRATED TRUSS SYSTEMS INC (Circle One) <br /> Account Balance as of 2/1/2013: $120.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> P aMelement and Descdption Record ID Employee ID and Name Status New Owner? Delete <br /> 4192 -HMBP-Common Materials PR0520946 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 4-HAZ MAT BUSINESS PLAN AUTHORIZATIOtPRO518021 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0518020 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHrPRO533657 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,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identifed as the OWNER on this form Ialso certify that all operations will be Performed in accordance with all applicable Ordinance Codes andor Standards and State and« <br /> Fetleral Laws. <br /> APPLICANTS SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I /_ <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Type Check Number Receivell! <br /> REHS: Date�l�/ \�� Account out: V <br /> Y Date / I <br /> COMMENTS: <br />