Laserfiche WebLink
Date run 8/10/2005 11:43:46AI SAN JOA' IN COUNTY ENVIRONMENTAL tMAL" DEPARTMENT Report#5021 <br /> Run by <br /> " v Facility Information as of 8l10/200�-"" Pagel <br /> Record Selection Criteria: Facility ID FA0015499 <br /> Make changes/corrections in RED Ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION F t" <br /> Owner ID OW0012452 .�.�—�'�"' New Owner ID <br /> Owner Name VICTOR BEJARANO <br /> Owner DBA V&S MOBILE TRUCK REPAIR <br /> Owner Address 474 S AURORA ST <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/Business Phone 209465-1664 <br /> Mailing Address 474 S AURORA ST <br /> STOCKTON, CA 95203 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015499 <br /> Facility Name V&S MOBILE TRUCK REPAIR <br /> Location 474 S AURORA ST <br /> STOCKTON, CA 95203 <br /> Phone 209-465-1664 <br /> Mailing Address 474 S AURORA ST <br /> STOCKTON, CA 95203 <br /> Care of \ <br /> Location Code Q 01(S'T�-,�.J APN: <br /> BOIS District ODI SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026741 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name VICTOR BEJARANO (Circle One) <br /> Account Balance as of 8/10/2005: $0.00 <br /> (Cine One) <br /> Transfer o Ac(ivennactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2244-PACT TRANSFER RECORD-DES PRO522728 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all SRO,and/or project spec,PHS/EHD hourly charges associated with this <br /> facility or activRy 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 Ordinace Codes and/or Standards and <br /> State andtor Federal Laws. <br /> APPLICANTS SIGNATURE: Date (!F/—(6 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$558.00= Amount Paid Date ! / <br /> Payment Type Check Number Received by <br /> REHS: Date /�/Account out Date�/ �� <br /> COMMENTS: n <br /> 7 d <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />