Laserfiche WebLink
Date run 2/13/2014 11:40:30AI SAN JO UIN COUNTY ENVIRONMENTAL HEAT 'DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 2/13/2014 <br />Record Selection Criteria: Facility ID FA0017309 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0014150 <br />Owner Name <br />COOPER OUT WEST <br />Owner DBA <br />COOPER OUT WEST <br />Owner Address <br />18636 E MILTON RD <br />Mailing Address <br />LINDEN, CA 95236 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />-1-8636--E-MII=TON-RD— <br />LINDEN, CA 95236 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID/CERS ID FA0017309 10,186,251 <br />Facility Name <br />COOPER OUT WEST <br />Location <br />19180 HARROLD <br />ESCALON, CA 95320 <br />Phone <br />209-467-1324 <br />Mailing Address <br />T86-3f-E-Mit–TON-RD <br />LINDEN, CA 95236 <br />Care of <br />Location Code <br />BOS District <br />APN 24903033 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0030191 <br />Mail Invoices to Owner <br />Account Name COOPER OUT WEST <br />Account Balance as of 2/13/2014: $266.00 <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 />Transferto Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1958 - HM -Farm Operations PR0525494 Active Y N A I D <br />2220 - SM HW GEN <5 TONS/YR PR0529821 EE0009001 - ELENA MANZO Active Y N A I D <br />2830 - AST FAC - SPCC EXEMPT PRO529820 EE0009001 - ELENA MANZO Active,l Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0531687 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 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 Ordinance Codes and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: Date <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS <br />* $25.00 = Amount Paid _ <br />Amount Paid <br />Date / /. <br />Date <br />Date <br />Recep'vv dby <br />Account out: 1I Date <br />/ <br />