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Date run : 3/24/00 8:52:41AM SAN XQUIN COUNTY PUBLIC HEALTH SER' ES Report #: 0002 <br /> Page #: 1 <br /> Run by SDRISCOL <br /> 1..i Facility Information as of 3/24/00 <br /> Record Selection Criteria: Facility ID FA0010972 <br /> Record I ' <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner to: OW0008972 Case Number: H09070 New Owner ID <br /> Owner Name: NANCY & DAN FRANZIA <br /> Owner DBA: <br /> Owner Address: <br /> Home Phone: Not Specified <br /> Work/Bussness Phone: 209-823-0534 <br /> Mailing Address: 1113 SHAW RD <br /> Care of: <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0010972 <br /> Facility Name: BIG VALLEY TRACTOR LLC N D ( &2&Cr.G4-i �71M <br /> Location: 3355 N AD ART RD � � SCO <br /> STOCKTON, CA 952152237 <br /> Phone: 37 <br /> Mailing Address: 3355 N AD ART RD <br /> Care of: CHUCK IKER <br /> Location Code: 99- UNINCORPORATED AREA APN, 087-100-40 <br /> BOS District: 002 -MARENCO, DARIO SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0017972 New Account ID:: <br /> Mail Invoices to: Account Mail Invoices to: Owner/Facility/Account <br /> Account Name: BIG VALLEY TRACTOR LLC (Circle One) <br /> Account Balance as of 3/24/00: $0.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514475 EE0000008-BRIGGS Active Y N A 8 D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FI PR0510972 EEO000000-SJC DES Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513260 EEOOOOOOO-SJC OES Active 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 <br /> project specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this <br /> form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal <br /> Laws. <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date / / <br /> Payment T e Check Number Receipt Number Received by <br /> RENS: Date_—111/_00 Account out: Date <br /> UUMMIMNA 5: <br /> 1.0.0.89.00 <br />