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Date run 5/612008, 3:38:16PM SANWQUIN COUNTYENVIRONMENTALI TH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/672008 <br /> Record Selection Criteria: Facility ID FAD003953 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION _ <br /> Owner ID OW0002917 New Owner ID 4 ?�� <br /> Owner Namevlr�vrv�mcert-�,�i —13 r <br /> Owner DBA ' <br /> OwnerAddree.. 21-1:'0 CAMINO RAMON <br /> SAN RAMON, CA 945835000 <br /> Home Phone 925-823-7430 <br /> Work/Business Phone 877-823-9833h-_ <br /> Mailing Address PO BOX 5095 3-4/W1 �EDOO <br /> SAN RAMON, CA 945830995 <br /> Care of SBC ENVIRONMENTAL MGMT <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003953 or <br /> Facility Name!R""�'-' A <br /> Location 7717 ELM ST <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-982-0010 <br /> Mailing Address PO BOX 5095 4 Tort" 3E000 <br /> SAN RAMON, CA 945830995 <br /> Care of <br /> Location Code 99 - UNINCORPORATED AREA APN: <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9600 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003564 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name�.,,_� — (circle One) <br /> Account Balance as of 5/6/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0511789 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> 2226-CalARP PROGRAM PRO514602 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0519685 EE0000000-HAZ MAT SJC OES Active Y N A 1 D <br /> 2301 SURCHARGEFEE PRO507737 EE0007289-ALISON YOUNGBLOODInactive Y N A �L] D <br /> 2361 ST FACILI PR0231870 EE0008317-RAYMOND VON FLUE Inactive Y N Ad D <br /> 2399-ON GRAM FAC STATE SURCHARPR0507543 EE0008317-RAYMOND VON FLUE Inactive Y N A I D <br /> BILLING and CO PLIANCE 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 <br /> facility or activity 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 Ordinace Codes and/or Standards and <br /> State andror Fed I Laws. <br /> APPLICANT NATURE: Date <br /> Program Re ds to be TRANSFERED: '$20.00= Amount Paid Date / / <br /> Water Syste to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Ty eck Number Receiv n <br /> REHS: Date 15 / OeAccountout: _ Date /v <br /> COMMENTS: <br /> Z© <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt n� �� \ �3�0 71 � <br />