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Date run 7/3/2008 10:47:38AM SAN JO `JIN COUNTY ENVIRONMENTAL HEA' I DEPARTMENT Report#5021 <br />Run by . 4 Pagel <br />Facility Information as of 7/3/200b <br />Record Selection Criteria: Facility ID FA0009836 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0007067 Case Number: H00790 <br />Owner Name <br />MANTECA UNIFIED SCHOOL DIST <br />Owner DBA <br />Owner Address <br />2901 E LOUISE AVE <br />209-825-3200 <br />LATHROP, CA 95330 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-825-3200 <br />Mailing Address <br />PO BOX 32 <br />MANTECA, CA 95336 <br />Care of <br />DENISE MATHEWS <br />FACILITY FILE INFORMATION <br />Facility ID <br />FAD009836 <br />Facility Name <br />MANTECA UNIFIED SCHOOL DIST <br />Location <br />2901 E LOUISE AVE <br />LATHROP, CA 95330 <br />Phone <br />209-825-3200 <br />Mailing Address <br />PO BOX 32 <br />MANTECA, CA 95336 <br />Care of <br />ROY YOST-TRANSPORTATION <br />Location Code <br />BOS District <br />003 - MOW, VICTOR <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0016836 <br />Mail Invoices to Owner <br />Account Name MANTECA UNIFIED SCHOOL DIST <br />Account Balance as of 7/3/2008: $0.00 <br />Make changes/corrections in RED ink or pencil. <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 />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inaclve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />2220 - SM HW GEN <5 TONS/YR PR0514057 EE0002670 - MUNIAPPA NAIDU Active Y N A I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHOR IZATIOIPRO512124 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />2244 - PACT TRANSFER RECORD - OES PR0519905 EE0000000 - HAZ MAT SJC OES Active Y N A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHAR1PR0509836 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />4740 - WASTE TIRE SITE - EXEMPT PR0524233 EE0000060 - JENNIFER FRASE 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 specific, 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 T A G 'T/ v v -2-93) 93) <br />APPLICANT'S SIGNATURE: Date <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS: <br />\\phs-ehsql-nt\apps\envisions\reports\5021. rpt <br />$20.00 = Amount Paid <br />$372.00 = Amount Paid _ <br />Date / / Account out: <br />Date <br />Date <br />Receivebny� <br />Date / (/L l 47 <br />