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BILLING
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WOODBRIDGE
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3750
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1900 - Hazardous Materials Program
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PR0536808
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BILLING
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Entry Properties
Last modified
10/30/2020 11:15:01 PM
Creation date
6/12/2018 9:00:58 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
BILLING
RECORD_ID
PR0536808
PE
1921
FACILITY_ID
FA0021140
FACILITY_NAME
CYCLES GLADIATOR WINERY
STREET_NUMBER
3750
Direction
E
STREET_NAME
WOODBRIDGE
STREET_TYPE
RD
City
ACAMPO
Zip
95220
APN
01322007
CURRENT_STATUS
Inactive, non-billable
SITE_LOCATION
3750 E WOODBRIDGE RD
P_LOCATION
99
P_DISTRICT
004
Supplemental fields
FilePath
\MIGRATIONS\W\WOODBRIDGE\3750\PR0536808\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
7/22/2015 8:52:20 PM
QuestysRecordID
2808560
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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Rate nun 4/3/2014 10:16:56AM SAN JOIE <br /> IN COUNTY ENVIRONMENTAL HEA DEPARTMENT Paget DEPARTMENT Report#5021 <br /> Ranby Facility Information as of 4/3/2014 <br /> Record Selection Criteria: Facility ID FAD021140 <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 OW0017415 New Owner ID <br /> Owner Name SMITH & HOOK WINERY <br /> Owner DBA CYCLES GLADIATOR WINERY <br /> Owner Address 3750 E WOODBRIDGE RD <br /> ACAMPO, CA 95220 <br /> Home Phone Not Specified <br /> Work/Business Phone 831-678-2132 <br /> Mailing Address PO BOX 40 <br /> ACAMPO, CA 952200040 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0021140 10,187,765 <br /> Facility Name CYCLES GLADIATOR WINERY <br /> Location 3750 E WOODBRIDGE RD <br /> ACAMPO, CA 95220 <br /> Phone 831-585-8756 x0 <br /> Mailing Address PO BOX 40 <br /> ACAMPO, CA 952200040 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 01322007 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 AR0038125 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name SMI INERY (Circle One) <br /> Account Balance as of 4/3/201 . P• — <br /> (Circle One) <br /> Transfer to Active/Inactee <br /> Program/Element and Description RecoN ID Employee ID and Name Status New Owr Delete <br /> 1921 -HMBP-Regular-Primary Location PR0536808 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0536857 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also cartity that all operations will be performed in accordance with all applicable Ordinance Codes andar Standards and Stale anaor <br /> Federal Laws. Ir/�' 1 <br /> APPLICANTS SIGNATURE: Pl c_a GC,,V S"�— 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 Received by / <br /> RENS: Date /_a/ �/4 <br /> Account out: Date / 2r / ` <br /> COMMENTS: <br />
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