BILLING - Laserfiche WebLink

Home Browse Search

Date run 3/10/2016 9:15:58AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 115021 Run by Pagel Facility Information as of 3/10/2016 Record Selection Criteria: Facility ID FA0017043 OWNER FILE INFORMATION Number of facilities for this owner Owner ID OW0013884 Owner Name SAS FARMS Owner DBA SAS FARMS Owner Address 16501 TRACY BLVD Phone TRACY, CA 95304 Home Phone Not Specified Work/Business Phone 209-481-5160 Mailing Address 16501 S TRACY BLVD Location Code TRACY, CA 95304 Care of 005 - ELLIOTT, BOB FACILITY FILE INFORMATION Facility ID / CERS ID FA0017043 10185801 Facility Name SAS FARMS Location 12434 S CAL PACK RD Transfer to STOCKTON, CA 95206 Phone 209-481-5160 x Mailing Address 16501 S TRACY BLVD 1958 - HM -Farm Operations PR0525228 EE0002670 - MUNIAPPA NAIDU TRACY, CA 95304 Care of Vernon Arnaudo Location Code 99 - UNINCORPORATED P BOS District 005 - ELLIOTT, BOB APN 18925023 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0029925 Mail Invoices to Account Account Name SAS FARMS Account Balance as of 3/10/2016: $266.00 Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN /Fed Tax ID New Owner ID : Alt Phone Fax EMail : Mail Invoices to: New Account ID: : Owner / Facility / Account (Circle One) Water System to be TRANSFERED: Payment Type Check Number EHD Staff: /,I o✓/�/�Yc� COMMENTS: Amount Paid Date Received by Date 3 / ! U / i6 Account out: /, r Date dtJ4 iQ f Dvn � QE� I oice #: (Circle One) Transfer to Active/Inactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1958 - HM -Farm Operations PR0525228 EE0002670 - MUNIAPPA NAIDU Active Y N Ag D 2220 - SM HW GEN <5 TONS/YR PRO530971 EE0001459 - VICKI MCCARTNEY Active Y N A D 2830 - AST FAC - SPCC EXEMPT PRO530970 EE0001459 -VICKI MCCARTNEY Inactive Y N A I D ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0534259 Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that e, 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 erform accorda a with all applicable Ordinance Codes and/or Standards and State and/or Federal Laws. n APPLICANT'S SIGNATURE: �� Date Program Records to be TRANSFERED: " $25.00 = Amount Paid Date Water System to be TRANSFERED: Payment Type Check Number EHD Staff: /,I o✓/�/�Yc� COMMENTS: Amount Paid Date Received by Date 3 / ! U / i6 Account out: /, r Date dtJ4 iQ f Dvn � QE� I oice #: