Laserfiche WebLink
Dalt run 2/22/2011 10:37:04AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by 5290 Pagel <br /> Facility Information as of 2/22/2011 <br /> Record Selection Critena: Facility ID FA0014092 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) Ij <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011155 New Owner ID : <br /> Owner Name FONTES, ARLIND 0w�JrAre.� , 1 rANk <br /> Owner DBA <br /> Owner Address gT#gg BLOSSOM RD C1 D . 94a;hr. <br /> THORNTON, CA 95686 <br /> Home Phone Not Specified <br /> WorkBusiness Phone No"Spe fjed- V1,01 <br /> Mailing Address p�$g {3 P.O, Sed[ 61-S <br /> THORNTON, CA 95686 <br /> Care of F€2F1T€S,AR6'PdD <br /> FACILITY FILE INFORMATION <br /> FacilityID FA0014092 <br /> FacilityName FOIJTES,O;R42{ 99.242- Q d FYbN1< <br /> Location 11665W BARBER RD <br /> THORNTON, CA 95686 <br /> Phone-2,9®=7g4-'267 7 Q�— <br /> Mailing Address PO BOX'J5 , ) ` -A Cis <br /> THORNTON, CA 95686 <br /> Care of F;gp}FE—g, Afil=INQ q qY ,W <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 00112001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Q Q L <br /> Title <br /> Day Phone _ <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0023829 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name FONTES,ARLIND 39-292 (Circle One) <br /> Account Balance as of 2/22/2011: $280.00 <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 TONSNR PR0529132 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525827 Active Y N A I D <br /> 2795-EMPLOYEE HOUSING-HISTORICAL CAMPSPRO518716 EE0002646-THUY TRAN Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0529131 EE0001422-ARIS CACAPIT Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO533453 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 pmject spec,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 /> APPLICANT'S SIGNATURE: Date ! / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: �`t1'�' Date / / it Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />