Laserfiche WebLink
ERecordseleGtion <br /> 7/2008 1:55:18PA SAN JO A'JIIN COUNTY ENVIRONMENTA. L HEA - DEPARTMENT Report#5021 <br /> ' , <br /> r <br /> f Facility Information as:of 1117/20t7S Pagel <br /> riteria: Facility ID FAGO09955 <br /> Make changestcorrections in RED ink or pencil. <br /> <F INFORMATION CHANGE(date)' <br /> i1 OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax.ID r <br /> Owner ID pW0002917 jir New Owner ID <br /> Owner Name PACIFIC BELL/ENVIRONMENTAL�MGT 7' CS' <br /> Owner DBA <br /> Owner Address 2000 CAMINO RAMON <br /> SAN RAMON, CA 945830995 <br /> Home Phone 925-823-7430 p <br /> Work/Business Phone 877-823-9833 <br /> Mailing Address PO BOX 5095 ROOM 3E000 •'0 - D 1G a <br /> SAN RAMON, CA 945830995 JV,0 k1 Ad <br /> Care of 4 <br /> .Et • <br /> FACILITY_ FILE INFORMATION <br /> Facility ID FA0009955 <br /> Facility Name _Q T LVLA'9 LA 55 SVC5 <br /> Location 8499 W OAK ST • <br /> THORNTON, CA 95686- <br /> Ph one <br /> 5686- <br /> Phone 209-943-4272 0 ID <br /> Mailing Address PO BOX 5095 RM 3E000T <br /> SAN RAMON, CA'94583 �,b d-30 <br /> Carve of ENVERONMENTAL MGMT S/a C' <br /> Location Code 99- UNINCORPORATED A Alt 1. <br /> BOS District 064 -VOGEL, KEN <br /> APN 00122009 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Ly �/ <br /> Title <br /> Day Phone I <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016955 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name PACIFIC BELL (Circle One) <br /> Account Balance as of 111712008: $0.00 <br /> (Circle One) <br /> Transfer 1o" Active/inactve <br /> ProgramlElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512243 EE 0000000-:HAZ MAT SJC OES Inactive Y N A' I D <br /> 2226-CalARP PROGRAM PR0514700 EEob00000-HAZ MAT SJC OES Inactive -Y N" A' I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0509955 EE0000000-HAZ MAT SJC OES inactive" Y N A"" I D <br /> a;: <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of;same,acknowledge that all site,and/or project specific,PHS/FHD 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 al'dperations will be performed in accordance with all applicable Ofdinace Codes and/or Standards and <br /> t State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date 1 ! <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date I I <br /> Payment Type Check Number Receiv d <br /> RENS: L' - Date�I /�31 Account out: Date <br /> COMMENTS: `F <br /> ' 4 <br /> llphs-ehsgl-ntla ppslenvisionslreports15021.rpt <br />