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Dale mm 3/8/2010 8:47:25AM SAN JC ')UIN COUNTY ENVIRONMENTAL HEA' TH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/8/20 <br /> Record Selection Criteria: FacilityID FA0010825 <br /> Make changes/corrections In RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008822 New Owner ID <br /> Owner Name VINTAGE PRODUCTION CA LLC <br /> Owner DBA <br /> Owner Address PO BOX 459 <br /> WOODLAND, CA 95776 <br /> Home Phone tSpec�ed <br /> Work S, iness Phone g1 -661-3966 '7D 37y ( L <br /> Mailing Address PO X 609 <br /> RIO V T\57112 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010825 <br /> Facility Name VINTAGE PRODUCTION CA L C <br /> Location 2147 W BOWMAN RD <br /> STOCKTON, CA 95206 <br /> Phone 707-374-6428 <br /> Mailing Address 9600 MING AVE STE 300PZ <br /> BAKERSFIELD, CA 93311 014 S / <br /> Care of ACCOUNTS PAYABLE <br /> Location Code 99-UNINCORPORATED A Alt Phone <br /> BOS District 003-BESTOLARIDES Fax <br /> APN 191-140-01 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017825 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner I Facility I Account <br /> Account Name VINTAGE PRODUCTION CA LLC (Cxae One) <br /> Account Balance as of 3/8/2010: $26200 <br /> (Circle One) <br /> Transfer to Actiyellnacrve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Omer! Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO517955 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0513113 EE0000000-HAZ MAT SJC OES Inactive Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO510825 EEo000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO533603 Active Y N A�D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,me undersigned owner,operator or agent of same,aanowledge Nat all site,and/or project spedfic,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the parry Identified as me OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: 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 Check Number Recei y <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> 79�0 <br /> \\eh-env\envision\reports\5021.rpt <br />