Laserfiche WebLink
Nate run '2/22/2007 10:05:02AI SAN JOA - 'IIN COUNT1Pagelt ENVIRONMENTAL <br /> HEALDEPARTMENT sazt <br /> Pagel <br /> Run by <br /> Facility Information as of 2122/200.1 <br /> Record selection Criteria: Facility ID FA0013598 <br /> Make changes/corrections in RED In r ./�, <br /> F a.. INFORMATION CHANGE(date) <br /> �r�� ■��� OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010715 New Owner ID <br /> Owner Name e <br /> Owner DBA E 9, de • <br /> Owner Address 4:320&4qVVf4tNG�M 0 KI Q I <br /> 1 Tc�wiT`—"c�� Lgd, c mT17 <br /> Home Phone Not Specified <br /> Work/BusinessPhone 209-744-9058 33,1,- Ef 1 <br /> Mailing Address PO BOX 2693 <br /> LODI, CA 95241 _ '2�4 <br /> Care of rr <br /> FACILITY FILE INFORMATION ( 7 <br /> Facility ID FA0013598 <br /> Facility Name C j� L/; k:{y .v , �rw..1�C J�'�I(�•ILVL^ <br /> v <br /> Location 1102 BLACK DIAMOND WAY 01 <br /> LODI, CA 95240 / <br /> Phone 209-334-4331 <br /> Mailing Address PO BOX 2693 <br /> LODI, CA 95241 <br /> Care of <br /> Location Code APN:04918020 <br /> BOS District 004-SEIGLOCK, JACK SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account 1D AR0022732 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AMERICAN FIRE SYSTEMS INC (CmdeOne) <br /> Account Balance as of 2/22/2007: $44X00 <br /> (Circle One) <br /> Trarwferto <br /> /AdNMreclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer? `/ Delete <br /> 2220-SM HW GEN<5 TONSNR PR0517809 EE0000753-WILLIE NG Active Y N D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO517811 EED000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO520972 EEOOOOOOO-HAZ MAT SJC OES Active Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0517810 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> 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 associa ad with this <br /> facility or activity will be billed to the parry identified as the OWNER an this form. I also certify that all operations will be performed in accordance with all applicable Ominace Codes anNor Ste Ms and <br /> State andror Federal Laws. `\ P ,, <br /> o <br /> APPLICANTS SIGNATURE: S Z e- a 'et Gc e-". . LV2 S Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date ! / <br /> Payment Type , t Check Number Received by <br /> RENS: L'il t-L^-lirL>FIY' Date /�l� Account out: Date ! 2 /0 _ <br /> COMMENTS' L WGLQfl1/ btj � ( e9�ti C <br /> \\phs�hsgl-nt\apps\envisions\reports\5021.rpt <br />