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JN R ort 15021 <br /> Date run 6/30/2006 9:57:26AA SANJO" 'lIN COUNTY LENVIRONM:ENTALHIAT T DEP Tl1 1Ran°y %'' Facilirmatio6/30/200 L <br /> Record Selection Criteria: Facility ID FA0014715 <br /> Make changes/corrections in RED ink or pencil. <br /> J <br /> INFORMATION CHANGE(date) (P ��O3 Olo <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION a <br /> Owner ID OW0011726 New Owner ID <br /> owner Name LOUIE J SCARES <br /> Owner DBA OLYMPIC TUNE <br /> Owner Address 1026 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1026 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014715 <br /> Facility Name OLYMPIC TUNE <br /> Location :1026 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Phone 209-334-0617 <br /> Mailing Address 4-00 N. C.luff AVe• <br /> Leet �l I rd i OA. o15 24-0 – 0-12-5 <br /> Care of <br /> Location Code APN: <br /> BOS District 004-SEIGLOCK, JACK SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025022 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name LOUIE JSOARES (Circe One) <br /> Account Balance as of 6/30/2006: $0.00 <br /> (Circle One) <br /> Transfer to Adive/Inadve <br /> Program/Elemeat and Description Record ID Employee ID and Name Status New OwneO Delete <br /> 2220-SM HW GEN<5 TONSNR PRO522234 EED008493-LORI LUCES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0521641 EEo000000-HAZ MAT SJC OES Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of some,acknoWedge that all site,andfor pmjed specific,PHS/EHD hourly charges associated with this <br /> facility or activity will Ee billed to Me 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 and/or Federal Lars. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date ! I <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number —Received/bb��y <br /> �/ <br /> REHS: %�1 e.,. Dale 30 /� Account out: r Z Date —7 / c3 / 0L <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />