BILLING - Laserfiche WebLink

Home Browse Search

Date run 11/18/2011 11:45:15/ SAN Jr ?UIN COUNTY ENVIRONMENTAL HEP 'H DEPARTMENT Report 715021 Run by Pagel Facility Information as of 11/18/21 Recom selectron cmena: Facility ID FA0014414 OWNER FILE INFORMATION Owner ID OW0011456 Owner Name PACIFIC STATE BANK Owner DBA RABOBANK N A Owner Address 1407 1 ST APN MODESTO, CA 95354 Home Phone 209-577-8878 Work/Business Phone Not Specified Mailing Address 1407 1 ST Employee ID and Name MODESTO, CA 95354 Care of KENDAU BATES FACILITY FILE INFORMATION Facility ID FA0014414 Facility Name FORECLOSED PROPERTY Location 635 AURORA ST STOCKTON,CA 95203 Phone 209-557-8878 Mailing Address 1407 1 ST EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name KENDAU BATES Title Day Phone 209-870-3221 Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0024494 Mail Invoices to Facility Account Name FORECLOSED PROPERTY Account Balance as of 11/18/2011: $0.00 Make changes/conections in RED ink. INFORMATION CHANGE (date) l l11 1 OWNERSHIP CHANGE (date) SSN / Fed Tax ID New Owner ID : Alt Phone Fax EMail : New Account ID: : Mail Invoices to: Owner I Facility I Account (Circle One) MODESTO, CA 95354 Care of KENDAU BATES Location Code 01 - STOCKTON BOS District 001 - VILLAPUDUA APN 14730004 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name KENDAU BATES Title Day Phone 209-870-3221 Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0024494 Mail Invoices to Facility Account Name FORECLOSED PROPERTY Account Balance as of 11/18/2011: $0.00 Make changes/conections in RED ink. INFORMATION CHANGE (date) l l11 1 OWNERSHIP CHANGE (date) SSN / Fed Tax ID New Owner ID : Alt Phone Fax EMail : New Account ID: : Mail Invoices to: Owner I Facility I Account (Circle One) 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 weh this facility or activity, WIII be billed to the party idenfified as the OWNER on this form. I also certify that all operations Will be performed in accordance with all applicable Ordinace Codes andlor Standards and State andlor Federal Laws. APPLICANTS SIGNATURE: Date Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment T e Check Number J1 e�/�l /l1 ��J/"I I U I� �✓n�' J( V�V'f [ c�//lrRe�civ REHS: Date Account out: e� Da COMMENTS: tn \\eh-en%Aenvision\reports\5021. rpt (Circle One) Transfer to Active/Inact e Program/Element ant Description Record ID Employee ID and Name Status New Owner? Delete 2220 - SM HW GEN <5 TONS/YR PRO528613 EE0001421 - STACY RIVERA Active Y N A I D 2244 - PACT TRANSFER RECORD - DES PRO519272 EE0000000 - HAZ MAT SJC DES Inactive Y N A I D ERSC - ELECTRONIC REPORTING STATE SURCHPRO533763 Active Y N A I D 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 weh this facility or activity, WIII be billed to the party idenfified as the OWNER on this form. I also certify that all operations Will be performed in accordance with all applicable Ordinace Codes andlor Standards and State andlor Federal Laws. APPLICANTS SIGNATURE: Date Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment T e Check Number J1 e�/�l /l1 ��J/"I I U I� �✓n�' J( V�V'f [ c�//lrRe�civ REHS: Date Account out: e� Da COMMENTS: tn \\eh-en%Aenvision\reports\5021. rpt