Laserfiche WebLink
t <br /> Date run 6/10/2008 7:37:23AN SA )AQUIN COUNTY ENVIRONMENTAL !.LTH DEPARTMENT <br /> Repos#5021 <br /> Run.".y Pagel <br /> Facility Information as of 6/10/2008 <br /> Record Selection Criteria: Facility ID FA0014402 <br /> 4P^1 /79.� VZ 0 Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011444 New Owner ID <br /> Owner Name <br /> Owner DBA F/tf IlG✓11 D <br /> Owner Address 4250 E MARIPOSA RD <br /> STOCKTON, CA 95215 <br /> Home Phone <br /> Work/Business Phone <br /> Mailing Address 2' d q / 7 'l o <br /> , <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014402 <br /> Facility Name ►� V C f% <br /> Location 4250 E MARIPOSA RD <br /> STOCKTON, CA 95215 <br /> Phone 209-r94;& <br /> Mailing Address-PCI`-150X-�594 <br /> 63y, 77 <br /> Care of zy <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024482 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name TE � L LUGS/Q,� (Circle One) <br /> Account Balance as of 6/10/2008: $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 /> 2244-PACT TRANSFER RECORD-OES PR0519260 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVEPRO528053 EE0000001 -LINDA TURKATTE 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 <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 Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date/1 <br /> Payment Type Check Number Receiv y <br /> REHS: c• _ Date / /G / 13 X Account out: Date <br /> COMMENTS: <br /> fav �ulFs�' G Lo S �,p �iivr- i�✓j-% <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />