BILLING - Laserfiche WebLink

Home Browse Search

Date run 2/16/2012 9:26:46AN SAN J 'JIN COUNTY ENVIRONMENTAL HEi DEPARTMENT Report#5021 Run by Pagel Facility Information as of 2/16/20'1 Record Selection Criteria. Facility—., FA0009564 Make changes/corrections in RED ink. INFORMATION CHANGE (date) -a4,!;1 2 61 OWNERSHIP CHANGE (date) OWNER FILE INFORMATION SSN / Fed Tax ID Owner ID OW0007564 New Owner ID Owner Name WONG, BILLY Owner DBA Owner Address 5919 ST ANDREWS DR STOCKTON, CA 95219 Home Phone 209-473-4781 Work/Business Phone 209-762-7200 Mailing Address PO BOX 30524 STOCKTON, CA 95213 Care of FACILITY FILE INFORMATION Facility ID FA0009564 Facility Name WONGS DIESEL SERVICE Location 1856 N BROADWAY AVE STOCKTON, CA 95205 Phone 209-937-0638 ^Aeilino Address PCS BOX 30524 6 I OCKTON, CA 95213 Care of t cation Code 01-STOCKTON IDS District 001 - VILLAPUDUA APN 14325003 EMERGENCY NOTIFICATION CONTACT INFORMATION contact Name '!e Day Phone Night Phone N\4/ V Alt Phone Fax _ EMail : ACCOUNTS RECEIVABLE FILE INFORMATION *\ VI, ` Account ID AR0016564 p6s, „�� m�� New Account ID: Flail Invoices to F?cilitV Mail Invoices to: Owner / Facility / Account count Name WONGS DIESEL SERVICE s, t h GQ 40.L (Circle One) 4" Account Balance as of 2/16/2012: $1,267.00 AO �D �—'' Zg3 Z Sin(—f_ W1 I W kIQ A� 1^ �/✓'e C� V Q o�d _ +b Z.ZZ�' -eo r S�� Z�jiy� rigrarhlE ent and Description Record ID Employee ID Name Status Transfer to (Circle One) Active/Inactve Delete and New Owner? �R]6- SM HW GEN <5 TONS/YR PRO513903 EE0009488 - JEFFREY WONG Active Y N A I D 224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0511852 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D 2244 - PACT TRANSFER RECORD - OES PRO519728 EE0000000 - HAZ MAT SJC OES Active Y N A I D 2399 - UNIFIED PROGRAM FAC STATE SURCHARPR0509564 EE0000000 - HAZ MAT SJC IDES Inactive Y N A I D 2832 - AST FAC 10 K- </=100 K GAL CUMULATIVEPRO515709 EE0009488 - JEFFREY WONG Active----, J ) =tC Y N A ;' I _;� D 4740 - WASTE TIRE SITE - EXEMPT PRO524495 EE0002622 - BENJAMIN ESCOTTO Active Y N A I D RSC - ELECTRONIC REPORTING STATE SURCHPRO534255 Active Y N A I D 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 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 State and/or Federal Laws, APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: " $25.00 = Water System to be TRANSFERED: Payment Type Check Number REHS: Date COMMENTS: \\eh-env\envision\reports\5021. rpt Amount Paid _ Amount Paid Account o Date