Laserfiche WebLink
Date run 2/13/2007 9:19:15AN SAN JOA`TIN COUNTY ENVIRONMENTAL HEALT-- DEPARTMENT Report#5021 <br /> Run by 4006 Pagel <br /> Facility Information as of 2/13/200T-� i(I\ <br /> Record Selection Critena: Facility 10 FA0010825 <br /> :111 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 VINTAGE PRODUCTION CA LLC <br /> Owner DBA <br /> Owner Address PO BOX 459 <br /> WOODLAND, CA 95776 <br /> Home Phone Not Specified <br /> Work/Business Phone 916-661-3966 <br /> Mailing Address PO BOX 609 <br /> RIO VISTA, 945711230 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010825 <br /> Facility Name VINTAGE PRODUCTION CA LLC <br /> Location 2147 W BOWMAN RD <br /> STOCKTON, CA 95206 Q <br /> Phone 707-374-6428 �TT� A-fP <br /> Mailing Address Pe-� 5"&- 3 O <br /> AILEl�6fr et�Ll)� CSA !73.7(f <br /> - <br /> care of VINTAGE PRODUCTION LLC <br /> Location Code 99-UNINCORPORATED AREA APN 191-140-01 <br /> BOIS 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 PRODUCTION CA LLC (Circle One) <br /> Account Balance as of 2/13/2007: $230.00 <br /> (Circle One) <br /> Transfer to Active/lnadve <br /> Program/Element and Description Record ID Employee ID and Name Status New Ownml Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0517955 EE0000753-WILLIE NG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO513113 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPR0610825 EE0000000-HAZ MAT SJC OES 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 spec.PHS/EHD hourly charges associated with this <br /> facility or activity will be Gilled to the parry identified as the OWNER on this form. 1 also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State andlor Federal Laws. � 1 <br /> APPLICANTS SIGNATURE: ����' � ^ ' �IN° ^-SSU Date / 13 /07 <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 Received by / <br /> REHS: Date l I Account out: Date 7�I (,__l <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />