Laserfiche WebLink
Date run 6/25/2007 9:33:18M SAN JUIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by 7f Pagel <br /> Facility Information as of 6/25/2 ul <br /> Record Selection Criteria: Facility ID FA0016278 <br /> Make changes/corrections in RED ink or penci. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002824 New Owner lD <br /> Owner Name FOWLER, DON W <br /> Owner DBA JIFFY LUBE#1478 (HAMMER) <br /> Owner Address 1700 N BROADWAY <br /> WALNUT CREEK, CA 94596 <br /> Home Phone 209-957-8730 <br /> Work/Business Phone Not Specified / <br /> Mailing Address 7 LI') ' �s�D/'C_„S,r-. <br /> LABI SA-952 <br /> Care of BROADBASE INC dba JIFFY LUBE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016278 <br /> Facility Name JIFFY LUBE#1478 <br /> Location 1648 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> Phone 209-957-8730 <br /> Mailing Address 740 c RFrtt nA I RD CTE a j �$ra r..Q� <br /> toot, a �52ue <br /> Care of BROADBASE INC dba JIFFY LUBE <br /> Location Code 01 - STOCKTON APN 08818032 <br /> BOS District SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0028468 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name JIFFY LUBE#1478 (circle One) <br /> Account Balance as of 6/25/2007: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inacwe <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2229-GEN 50<250 TONS PERMIT PR0524254 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0524482 Active Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PR0527167 EE0008317-RAYMOND VON FLUE Active 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 spedtic,PHS/EHD hourly charges associated with this <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date / / <br /> Payment Tye Check Number 22 R celved by �7 <br /> REHS `/� r44 Date�_/ ! _/ 6 Account out: G. Date-L/7.S / 0 I <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />