Laserfiche WebLink
Date run 3/27/2017 10:03:59AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 3/27/2017 <br />Record Selection Criteria: Facility ID FA0012406 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />Owner ID <br />OW0009620 <br />Owner Name <br />WESTERN BUILDING MATERIALS CO <br />Owner DBA <br />WESTERN BUILDING MATERIALS CO <br />Owner Address <br />4620 E OLIVE AVE <br />Mail Invoices to: <br />FRESNO, CA 93702 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />559-454-8500 <br />Mailing Address <br />4620 E OLIVE AVE <br />FRESNO, CA 93702 <br />Care of <br />FACILITY FILE INFORMATION <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner ID : <br />c t ✓ -I 1Vvi <br />Facility ID / CERS ID FA0012406 10184229 Q e C 1A <br />Facility Name WESTERN BUILDING MATERIALS CO <br />Location 2401 STAGECOACH RD L e /a 731 /T <br />STOCKTON, CA 95215 <br />Phone 209-464-9421 x l c� '7 rc C<_ ice! k.; , < E' <br />Mailing Address 4620 E OLIVE AVE <br />FRESNO, CA 93702 <br />Care of Western Building materials Co. <br />Location Code 01 - STOCKTON <br />Bos District 002 - MILLER, KATHERINE <br />APN 17332018 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0020263 <br />New Account ID: <br />: <br />Mail Invoices to Account <br />Mail Invoices to: <br />Owner / <br />Facility / <br />Account <br />Account Name WESTERN BUILDING <br />MATERIALS CO <br />(Circle One) <br />Account Balance as of 3/27/2017: $434.00 <br />(Circle One) <br />Transfer to <br />Active/Inactve <br />Program/Element and Description <br />Record ID <br />Employee ID and Name <br />Status <br />New Owner? <br />Delete <br />1921 - HMBP-Regular-Primary Location <br />PR0520926 <br />EE0008709 - JAMIE LIMA <br />Active <br />Y N <br />AI D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0515981 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y N <br />A D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F <br />PR0515982 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y N <br />A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG <br />PRO531865 <br />Inactive <br />Y N <br />A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andtor project specific, PHS/EHD hourly charges associated with this facility <br />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 <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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 <br />EHD Staff: MA Date /1_/1-7 Account out: Date 3 / Z7 / Z7 <br />COMMENTS: <br />Y10 1',) V o l a`\ G1Ka" �V <br />-c-9, Invoice #: <br />knt;�,J A - NU4 0�)L4 0 �w - <br />