Laserfiche WebLink
Date ren 7/14/2015 8:11:09AR SAN JOIN COUNTY ENVIRONMENTAL HEA*DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/14/2015 <br /> Record Selection Criteria: Facility ID FA0021629 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0017787 New Owner ID <br /> Owner Name BUCIO, ERICA V <br /> Owner DBA <br /> Owner Address 531 CHABLIS WAY <br /> MANTECA, CA 95337 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-261-0053 <br /> Mailing Address 531 CHABLIS WAY <br /> MANTECA, CA 95337 <br /> Care of BUCIO, ERICAV <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0021629 10399834 <br /> Facility Name MANTECA AUTO &TRANSMISSION <br /> Location 1162 BESSEMER AVE STE 1 / . <br /> MANTECA, CA 95337 <br /> Phone 209-261-0053 <br /> Mailing Address 531 CHABLIS WAY <br /> MANTECA, CA 95337 <br /> care of BUCIO, ERICA V <br /> Location Code 04-MANTECA Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 22119012 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ERICAV BUCIO I �1(� ✓W r\DSS C �0� ( L� 7�tLF <br /> Title OWNER <br /> Day Phone 209-261-0053 I <br /> Night Phone �� J <br /> ACCOUNTS RECEIVABLE FILE INFORMATION Gh <br /> Account ID AR0039194 New Account ID: <br /> Maillnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MANTECA AUTO &TRANSMISSION (Circle One) <br /> Account Balance as of 7/14/2015: $461.00 <br /> (Circle One) <br /> Transfer to ActivelracNe <br /> Program Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO537572 EE0009001 -ELENA MANZO Active Y N A (9 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project speck,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the paM identified as the OWNER on this forth I also comity that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State m,rcr <br /> Federal Laws <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: Date_/ /_ Account out: - Date <br /> COMMENTS: Invoice#: <br />