Laserfiche WebLink
Date run 4/24/2006 11:00:06AI SAN JOA^UIN COUNTY ENVIRONMENTAL HEAL" DEPARTMENT Report#5021 <br /> Run by L Facility Information as of 4/24/200$/- - Pfi Page1 <br /> Record Selection Cmena: Facility ID FA0010825 'Fir 1UL IV <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008822 Case Number H08817 New Owner ID <br /> Owner Name VINTAGEPEiROCEIINfitLC <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 916-661-3966 <br /> Mailing Address PO BOX 459 <br /> WOODLAND, CA 95776 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010825 <br /> Facility Name VINTAGE PE PR-G zL fvT�LC <br /> Location 2147 W BOWMAN RD <br /> STOCKTON, CA 95206 <br /> Phone 707-374-6428 <br /> Mailing Address PO BOX 2565 <br /> ADDISON, TX 750012565 <br /> Care of VINTAGE PETRDt 4JM+LG C, ✓ �i ✓ <br /> Location Code 99-UNINCORPORATED AREA APN 191-140-01 <br /> BOS District 003-MOW, VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017825 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name VINTAGE PEiROtEHM CCC (circle One) <br /> Account Balance as of 4/24/2006: $0.00 <br /> (Circle One) <br /> Transfer to AclWellname <br /> ProgrdmtElement and Descripgon Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSIYR PRO517955 EE0000753-WILLIE NG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO513113 EEOo00000-HAZ MAT SJC DES Inactive Y N A 1 D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARFIR0510825 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of some,ackrimedge mat all site,andtor project specific,PHS/EHD houry charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations vnll be performed in accordance with all applicable Ordinance Codes and/or Standards and <br /> Stale andtor Federal Laws. <br /> APPLICANTS SIGNATURE: S e- t= Date —L)(- <br /> Program <br /> L,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 Received by <br /> RENS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reporls\5021.rpt <br />