Laserfiche WebLink
Date run 11/14/2014 11:13:41/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> • Facility Information as of 11/14/2014 Pagel <br /> Recdrd Selection criteria: Facility ID FA0005287 <br /> Make changes/corrections In RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN/Fed Tax ID <br /> Owner ID OW0015119 New OwnerlD <br /> Owner Name DELTA TRANSPORT INC <br /> Owner DBA <br /> Owner Address 15135 W EIGHT MILE RD <br /> STOCKTON, CA 95219 <br /> Home Phone 925-890-5099 <br /> Work/Business Phone 209-9514634 <br /> Mailing Address 15135 W EIGHT MILE RD - ISLAND FERRY <br /> STOCKTON, CA 95219 <br /> Care of JOHNSON, DAVID <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility lD/CERS ID FA0005287 10181789 <br /> Facility Name H & H MARINA <br /> Location 15135 W EIGHT MILE RD <br /> STOCKTON, CA 95219 <br /> Phone 209-951-4634 x <br /> Mailing Address 15135 W EIGHT MILE RD <br /> STOCKTON, CA 95219 <br /> Care of JOHNSON, DAVE <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 06908021 Entail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005748 / vv 1 v New Account ID: <br /> Mail Invoices to Facility - Vl �� Mail Invoices to: Owner / Facility / Account <br /> Account Name H � (Circle One) <br /> Account Balance as of 11/1 12014: $470.00 <br /> (circle one) <br /> PrograMElement and Description Record ID Employee ID and Name Transferto Activellnactve <br /> status New Owner! Delete <br /> 1920-HMBP-Common Materials PR05195l EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0516679'/ EE0001422-ARIS VELOSO Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511629 EEo000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CalARP PROGRAM PRO514568 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO501969 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509341 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PRO516678 EE0001422-ARIS VELOSO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532787 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project specific,PHSEHD hourly charges associated with this facility <br /> directivity 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 ander Standards and State andror <br /> Federal Laws, <br /> APPLICANTS SIGNATURE: ��se—AdVI 6-f-" — 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 Account Account out: Date <br /> COMMENTS: �/ 4-� / /I I � � ,A <br />