Laserfiche WebLink
Date run 11/2012013 10:47:16! SAN JC UIN COUNTY ENVIRONMENTAL HEA J DEPARTMENT Report 45021 <br /> Run by ?r. �' Pagel <br /> Facility Information as of 11/20/2013 <br /> Record Selection Criteria: Facility ID FA0013662 <br /> Make changes/corrections in RED ink. j `4 <br /> INFORMATION CHANGE(date) 1 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0010771 New Owner ID <br /> Owner Name GROSS, BRYAN K <br /> Owner DBA <br /> Owner Address 5062 SHETLAND CT <br /> ANGELS CAMP, CA 95222 <br /> Home Phone 209-992-1650 <br /> Work/Business Phone 209-469-7091 <br /> Mailing Address 3166 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0013662 10,184,503 <br /> Facility Name ACCURATE AUTO BODY <br /> Location 3166 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Phone 209-469-7091 <br /> Mailing Address 3166 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOO District 002 - RUHSTALLER, LARRY Fax <br /> APN 11904331 Entail: Lod, rp 4q, <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ©� P/0`- <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022819 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner I Facility I Account <br /> Account Name ACCURATE AUTO BODY (Curcle One) <br /> Account Balance as of 11/20/2013: $0.00 <br /> (Circle One) <br /> Transferto Activellnactve <br /> PrograrnlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0521006 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2220-SM HW GEN c5 TONS/YR PRO518038 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0518040 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0518039 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PR0522994 EE0009488-JEFFREY WONG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532030 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specific,PHSlEHD hourly charges associated with this facility <br /> or activity well 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 ancVor Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / ! <br /> Program Records to be TRANSFERED: "$25,00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Paid Date I ! <br /> Payment Type Check Number Receive y <br /> RENS: Date I I Account out: . Date ! l <br /> COMMENTS' <br /> 12 2 1 13 <br />