Laserfiche WebLink
Date run 1/31/2013 2:22:46PN SAN J# :UIN COUNTY ENVIRONMENTAL HEY' i DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/31/2013 <br /> Record Selection Criteria: Facility ID FA0017283 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014124 New Owner ID <br /> Owner Name VACCAREZZADit <br /> Owner DBA VACCARE rR <br /> Owner Address 7790 __�N <br /> L EN O <br /> Home Phone Not SpeCll2d- <br /> Work/Bu 'ness Phone/ Not Specified <br /> I�a lSg Addre s 18380 E COMST CK R <br /> 41NDEN, CA 9 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017283 <br /> 1 <br /> Facility Name VACCAREZZA BROS —71700 <br /> Location 18380 E COMSTOCK RD <br /> --- <br /> LINDEN, CA 95236 <br /> Phone 209-887-3883 x0 <br /> Mailing Addr s 18380 E COMSTOCK R <br /> LINDEN, CA 95236 <br /> Car of -1 <br /> Location Code TED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 09124003 ail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030165 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name VACCAREZZA BROS (Circle One) <br /> Account Balance as of 1/31/2013: $0.00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> HM-Farm Operations PR0525468 Active Y N A I D <br /> 2840 AST EXEMPT FAC < 1,320 GAL PR0529547 EE0000753-WILLY NG Active,Exempt Y N A I D <br /> C-ELECTRONIC REPORTING STATE SURCH,PR0531257 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 ancVor <br /> 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 Da <br /> Payment Type Check Number Receiv <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> L <br />