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Date run 5/8/2013 2:51:35PM SAN JC IN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br />Run by , Pagel <br />Facility Information as of 5/8/2013 <br />Record Selection Criteria: Facility ID FA0016585 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0006399 <br />Owner Name <br />STOCKTON UNIFIED SCHOOL DIST <br />Owner DBA <br />2963 SANGUINETTI LN <br />Owner Address <br />1932 N EL PINAL FACILITY SERVICE <br />Phone <br />STOCKTON, CA 95205 <br />Home Phone <br />209-953-4452 <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />701 N MADISON ST <br />Location Code <br />STOCKTON, CA 95202 <br />Care of <br />002 - RUHSTALLER, LARRY <br />FACILITY FILE INFORMATION <br />Facility ID! CERS ID <br />FA0016585 10,185,209 <br />Facility Name <br />SUSD VEHICLE MAINTENANCE YARD <br />Location <br />2963 SANGUINETTI LN <br />STOCKTON, CA 95205 <br />Phone <br />209-933-7145 <br />Mailing Address <br />701 N MADISON ST <br />STOCKTON, CA 95202 <br />Care of <br />STOCKTON UNIFIED SCHOOL DIST <br />Location Code <br />99 - UNINCORPORATED P <br />Bos District <br />002 - RUHSTALLER, LARRY <br />APN <br />11708027 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />STOCKTON UNIFIED SCHOOL DIST <br />Title <br />Day Phone <br />209-933-7145 <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0029264 <br />Mail Invoices to Facility <br />Account Name SUSD VEHICLE MAINTENANCE YARD <br />Account Balance as of 5/8/2013: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />New Account ID: <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />ProgranUElement and Description Record ID Employee ID and Name Status New Owner? Delete <br />2831 - AST FAC >/= 1,320 - <10 K GAL CUMULATNPR0528152 EE0004636 - GARRETT BACKUS Active,Exempt Y N A D <br />4740 - WASTE TIRE SITE - EXEMPT PR0524691 EE0007379 - AMANDA BOERTIEN Active Y N A D <br />ERSC - ELECTRONIC REPORTING STATE SURCH,PR0534407 Inactive 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 project specific, PHS/EHD hourly charges associated with this facility <br />or activity will be billedo the party identified as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br />Federal Laws. <br />�r <br />` APPLICANT'S SIGNATURE: Date / U ! <br />Program Records to be TRANSFERED: ' $25.00 — Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Ty Check Number Rec _ <br />REHS: Date _rte! / Account out: Date <br />COMMEN &5;-, ` ! �o �o eA Oc�� � o l % p a► rc, l � <br />