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Date run 6/17/2003 3:44:21 Pk SAN 4W COUNTY ENVIRONMENTALDEPARTMENT Report #5021— <br />Run by Pagel <br />Facility Information as of 6/17 03 <br />Re,ord Selection Criteria: Facility ID FA0014604 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0011621 <br />Owner Name <br />CHARTER WAY AUTO RECYCLERS <br />Owner DBA <br />Owner -Address <br />930 E CHARTER WAY <br />STOCKTON, CA 95206 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address 930 E CHARTER WAY <br />STOCKTON, CA 95206 <br />Care of CHARTER WAY AUTO RECYCLERS <br />FACILITY FILE INFORMATION <br />FacilityID FA0014604 <br />Facility Name CHARTER WAY AUTO RECYCLERS <br />Location 930E CHARTER WAY <br />STOCKTON, CA 95206 <br />Phone <br />Mailing Address 930 E CHARTER WAY <br />STOCKTON, CA 95206 <br />Care of CHARTER WAY AUTO RECYCLERS <br />Location Code <br />BOS District <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0024849 <br />Mail Invoices to Facility <br />Account Name CHARTER WAY AUTO RECYCLERS <br />Account Balance as of 6/17/2003: $0.00 <br />ProgramlElemenl and Description Record ID Employee ID and Name <br />2217 -APPLIANCE RECYCLER <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />New Owner ID : <br />APN: <br />SIC Code: <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Omer? Delete <br />PR0521509 EE0008644 - DINA ABATE Active Y N <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andlor project specific, PHS/EHD hourly charges assoaista0mth 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: <br />Date <br />Program Records to be TRANSFERED: ' $20.00 = Amount Paid to <br />Water System to be TRANSFERED: -*$155.00= Amount Paid a <br />Payment Type� Check Number d by <br />REHS: Date Account out: <br />COMMENTS: <br />No OL+ -Ca�' diol &vx i `I�c,6C`A (11-11-06 <br />\\Phs�hsgl-nt\apps\Envisions\Reports\5021.rpt <br />