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10/22/2004 13:bl 4b41713tl <br /> Rlab" 021 <br /> tete nm 10/18/2004 2:01:GBP SA1�� '}'i <br /> QAIN COUN 'ENV,MONMEl�NAL HL,,'jI DEPARTt�iG'P1T Pnol <br /> Runby Facility Information as of.r0/1WgW4 — <br /> Record$wood a Cdnrle: Facility ID FA0009240 , <br /> Make changes/eotTecuorls in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> " OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> owner ID OW0007240 Case Number: H02322 N `'Ovmer tD : <br /> 1 +' le lino <br /> Owner Name FAITS, vuv"` rS / <br /> Owner DBA ELITE CLEANERS .i 1 i .e i ti_ {} I1 <br /> y; <br /> Owner Address 3208 AWTI61411N-�� <br /> STOCKTON,CA 95219 X20 4 9 yg <br /> Horne Phone Not Specified <br /> WorkBusiness Phone 209-957-9361 <br /> Mailing Address 3201 W BENJAMIN HOLT DR#119 <br /> STOCKTON, CA 95219 <br /> Care of <br /> FAciuTY Mg-I ORMATIONF - - - — <br /> Facility ID FA0009240 <br /> FaalibyName ELITE CLEANERS <br /> location 3201 W BENJAMIN HOLT DR 119 <br /> STOCKTON,CA 95219 <br /> Phone (zv R) 9 5'7-9 3 G/ <br /> Mailing Address 3201 W BENJAMIN HOLT DR#119 <br /> STOCKTON,CA 95219 <br /> Care of APN:10017009 <br /> Location Code 01 -STOCKTON SIC Code:9900 <br /> BOB District 002-MARENCO, DARIO <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> New NCC04M ID: <br /> AccountlD AR0016240 Mail Invoices to: OwnerFadhty A=Int <br /> Mail Invoices to Facility (circle one) <br /> Account Name ELITECLEANERS <br /> Account Balance as of 10!18/2004: $0.00 (throb are) <br /> Twafer le ACWMic <br /> Ne.O"a" Dome <br /> Record 10 Ealy% o ID and Name snore <br /> Programrtbma�t me Oeealptloe Y pl I D <br /> PRO513720 EE000358o-MICHELLE LE Inactive <br /> 2220-SM FIVV GEN<5 TONSIYR Y N I D <br /> 2224•HAY MAT BUSINESS PLAN AUTHORIZATIO PR0511528 EE0000000-HAY MAT BJC OES Inacdve Y N A 1 0 <br /> 2244-PACT TRANSFER RECORD-DES PRO520909 EE0000000-HAZ MAT SJC DES Active y N A I D <br /> 2399,UNIHED PROGRAM FAG STATE SERVICE fPRR050924A €E0000000-HAZ MAT SJC DES Inactive sc,rNsrLRo rovdy cnareee eeeoclalm'Am mm <br /> aILLING areCOMPLIANCE ACKNOWLEDGEMENT; 1,ole urdereigrred mrnar.W m w or arm at°am"'2clu-11 9a mat all:tie.a,Mla pmlect aPOc <br /> odRty or ee,*aai be b0ad n ere Pert Merldfed e9 the OWNER cit Ina farm. 12K cent mit en aderatba6 ora be paA -d in accordance-ftall ePplkebie Ordmece Co W'angor Stmaams are <br /> Soto andlor Fedor+!Laws. <br /> r Date <br /> XPPLICANT'S SIGNATURE: <br /> O Amount Paid Date <br /> $155.00 <br /> Program Records tO be TRANSFERED: $1 820.00= Q�- Amount Paid t6 ZO-'Date <br /> Water System to be TRANSFERED: ' = i Received by <br /> Payment Type ✓✓ Check Number S <br /> REHS: <br /> ,nA ^ D81B I a Accountout <br /> COMMENTS: <br /> RECEIVED <br /> OCT 2 8 20p4 <br /> SA ENVIRONME MENT <br /> HEN-TN DEPAR <br /> \Whaehsgl-nt\appslenvislalsVeports\5021.rpt <br />