BILLING - Laserfiche WebLink

Home Browse Search

Date run 9/26/2018 9:52:23AK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 Run by DONNA Pagel Facility Information as of 9/26/2018 Record Selection Criteria: Facility ID FA0009697 Account Balance as of 9/26/2018: $181.80 (Circle One) Transfer to Active/Inactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1920 - HMBP-Common Materials PR0511985 EE0000009 - NICHOLAS LOEHRER Active Y N Ai D 2220 - SM HW GEN <5 TONS/YR PR0513987 EE9999997 - TWO VACANT2 Inactive Y N A I D 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509697 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly charges associated with this facility 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 and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: * $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received by EHD Staff: 1 i� t", `I 1-7�— Date /_/_ Account out: Date COMMENTS: Invoice #: _ Nfl �hef�l cC�� on p Ns��sS Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) OWNER FILE INFORMATION Number of facilities for this owner : 28 SSN / Fed Tax ID Owner ID OW0002957 New Owner ID Owner Name Pacific Gas and Electric Company Owner DBA PG&E OwnerAddress 3401 CROW CANYON RD 176C SAN RAMON, CA 94583 Home Phone 925-415-6381 Work/Business Phone 415-973-7000 Mailing Address c/o Environmental Services, 3401 Crow Canyc San Ramon, CA 94583 Care of c/o Environmental Services FACILITY FILE INFORMATION Facility ID / CERS ID FA0009697 Facility Name PG&E VERNALIS DEHYDRATOR Location 1688 E DURHAM FERRY RD TRACY, CA 95304 Phone 209-942-5020 Mailing Address 375 N WIGET LN STE 130 WALNUT CREEK, CA 94598 Care of PACIFIC GAS & ELECTRIC CO Location Code Alt Phone BOS District 005 - ELLIOTT, BOB Fax APN 25523002 Entail: EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0016697 New Account ID: Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account Account Name PG&E VERNALIS DEHYDRATOR (Circle One) Account Balance as of 9/26/2018: $181.80 (Circle One) Transfer to Active/Inactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1920 - HMBP-Common Materials PR0511985 EE0000009 - NICHOLAS LOEHRER Active Y N Ai D 2220 - SM HW GEN <5 TONS/YR PR0513987 EE9999997 - TWO VACANT2 Inactive Y N A I D 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509697 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly charges associated with this facility 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 and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: * $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received by EHD Staff: 1 i� t", `I 1-7�— Date /_/_ Account out: Date COMMENTS: Invoice #: _ Nfl �hef�l cC�� on p Ns��sS