Laserfiche WebLink
Date run 12/20/2016 1:21:09P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 12/20/2016 <br />Record Selection Criteria: Facility ID FA0010715 <br />OWNER FILE INFORMATION Number of facilities for this owner: 6 <br />Owner ID <br />OW0007474 Case Number: H04385 <br />Owner Name <br />CITY OF LODI <br />Owner DBA <br />Owner Address <br />1331 S HAM LN <br />209-333-6740 <br />LODI, CA 95242 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-333-6740 <br />Mailing Address <br />1331 S HAM LN <br />LODI, CA 95242 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0010715 10183773 <br />Facility Name <br />-' E)BI WKFER ^"'- `"fel I 4R <br />Location <br />1215 THURMAN ST <br />LODI, CA 95240 <br />Phone <br />209-333-6740 <br />Mailing Address <br />1331 S HAM LN <br />LODI, CA 95242 <br />Care of <br />Location Code 02 -LODI <br />Bos District 004 - WINN, CHARLES <br />APN 04931008 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0017715 <br />Mail Invoices to Account <br />Account Name LODI WATER DIV <br />Account Balance as of 12/20/2016: $0.00 <br />Make changestcorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transferto Active/Inactve <br />Program/Element and Descdption Record ID Employee ID and Name Status New Owner? Delete <br />1926 - HMBP-Remote Network Location PR0513003 EE0008709 - JAMIE LIMA Active Y N A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FE PR0515846 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />2840 -AST EXEMPT FAC < 1,320 GAL PR0528455 EE0009488 - JEFFREY WONG Inactive Y N A I D <br />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 <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 for <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 Tyel Check Number Received / <br />EHD Staff: 14M& Date -17— / W/Account out: Date 12— I_26 <br />COMMENTS: <br />Invoice #: <br />