Laserfiche WebLink
Date run 2/13/2014 11:39:29AI SAN JO r SIN COUNTY ENVIRONMENTAL HEAT ;DEPARTMENT Report 115021 <br /> R ,4� z Pagel <br /> Run by Facility Information as of 2/13/2014 <br /> Record Selection Criteria: Facility ID FA0005082 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNI Fed Tax ID <br /> Owner ID OW0003962 New Owner ID <br /> Owner Name COOPER OUT WEST <br /> Owner DBA COOPER OUT WEST <br /> Owner Address 18636 E MILTON RD <br /> LINDEN, CA 95236 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address <br /> LINDEN, CA 95236 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0005082 10,181,727 <br /> Facility Name COOPER OUT WEST <br /> Location 29756 E ORANGE AVE <br /> ESCALON, CA 95320 <br /> Phone 209-467-1324 x0 <br /> Mailing Address <br /> LINDEN, CA 95236 <br /> Care of <br /> Location Code 06 - ESCALON Alt Phone <br /> Bos District 005 - ELLIOTT, BOB Fax <br /> APN 24919005 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 AR0005527 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner I Facility 1 Account <br /> Account Name COOPER OUT WEST (Circle One) <br /> Account Balance as of 211312014: $53,00 <br /> (Circle One) <br /> Transfer to AclivellnacNe <br /> Program/Element and Description Record 0 Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525911 Active Y N A I D <br /> 2333-FARM UST 91 FACILITY-obsolete PR0501371 EE0007289-ALISON YOUNGBLOOD Inactive Y N A 1 D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529937 EE0000753-WILLY NG Active,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533693 Inactivt Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this farm, I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andlor Standards and Stale andlor <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date 1 ! <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date 1 / <br /> Water System to be TRANSFERED: Amount Paid Date I ! <br /> Payment Type Check Number Re t by <br /> REHS: Date I 1 Account out: Date Z1 1 <br /> COMMENTS: <br />