Laserfiche WebLink
Date run 2/5/2013 3:14:10PM SAN JOIN COUNTY ENVIRONMENTAL HEAL*DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 2/5/2013 <br />Record Selection Criteria: Facility ID FA0018291 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0002055 <br />Owner Name <br />CALIFORNIA ARMY NATIONAL GUARD <br />Owner DBA <br />CALIF NATIONAL GUARD <br />Owner Address <br />10620 MATHER BLVD <br />MATHER, CA 956554125 <br />Home Phone <br />916-854-3334 <br />Work/Business Phone <br />916-361-3438 <br />Mailing Address <br />10620 MATHER BLVD <br />MATHER, CA 956554125 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID FA0018291 <br />Facility Name FMS #24 (OMS) <br />Location 8020S AIRPORT WAY <br />STOCKTON, CA 95206 <br />Phone <br />Mailing Address ATTN: HILYARD, SCOT <br />MATHER, CA 95655 <br />Care of ENVIRONMENTAL OFFICE <br />Location Code 99 - UNINCORPORATED P <br />Bos District 001 - VILLAPUDUA <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0032217 <br />Mail Invoices to Account <br />Account Name CALIF ARMY NATIONAL GUARD <br />Account Balance as of 2/5/2013: $-125.00 <br />ProgranVElement and Description <br />Record ID Employee ID and Name <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 />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Owner? Delete <br />2957 - UST FILE - RWQCB PRO526994 EE0000684 - MICHAEL INFURNA Active Y N A I L <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: <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 / / Account out: <br />Date <br />Date <br />Date <br />Received by <br />Date <br />