Laserfiche WebLink
Date run 117/11/00 3:34:37PM SAI'" )AQUIN COUNTY PUBLIC HEALTH SEI '."--ES Report #: 0002 <br /> Rugby (IDAV15 Facility Information as of 10/11/00 d Page <br /> Record Selection Criteria: Facility ID ,FA0009453 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner:ID: OW0007453 Case Number: H04066 New Owner ID <br /> Owner Name; ROBERT M CROW, WM H CROW JR <br /> Owner DBA: <br /> Owner Address• <br /> Home Phone; Not Specified <br /> WorklBussness Phone; 209-931-0879 <br /> Mailing Address: PO BOX 1927 <br /> Care of: <br /> FACILITY FILE INFORMATION <br /> Facility-ID: FA0009453 k <br /> Facility Name: STOCKTON ARMATURE & MOTOR WRKS <br /> Location:. 646 S CALIFORNIA ST ' <br /> STOCKTON, CAk 95203 i0 <br /> Phone: 209-46$_9625 <br /> Mailing Address: 646 S CALI FOR IA ST <br /> STOCKTON, CA,i 95203- <br /> Care of; ROBERT M CROW WM H CROW JR <br /> Location Code: 01 -STOCKTONI APN; 149-086-02 <br /> BOS District: 001 -GUTIERREZ, STEVE SIC Code; <br /> Ip. <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AccountllD: 6453 i ""u � pctib. New Account ID.: <br /> Mail Invoice st Accoun C'.� M�tL'� Mail Invoices to: Own / Facility 1 CCOUnt <br /> Account Name; CKTON ARMATURE & MOTOR WRKS ne) <br /> Account Balance as of 10111100: $0.00 <br /> {Circle One <br /> UST(s) Transfer to Activellnacty <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2399-UNIFIED PROGRAM IFAC STATE SERVICE F ;E PRO509453 EED000000-SJC DES Active Y N I <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORI7ATIO PRO511741 ;EE0000000-SJC OES Active Y N I <br /> 2220-SM HW GEN<5 TONSNR PRO513847 EE0000418-KITH Active Y N I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,and/orpro'ect <br /> spec!fic,PHS/EHD hourly charges associated with this facility or activity will be billed to theparty identified as the BILLING PARTY on thisform. <br /> also certify that all operatMons will be performed in accordance with all applicable Ordinace Codes an or Standards and State and/or Federal Laws <br /> APPLICANT'S SIGNATURE: Date ! / <br /> Program Records to be TRANSFERED: "":',$0.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: "$1'50.00= Amount Paid Date 1 / <br /> Payment Type Check Number Receipt Number `/ Received by <br /> RENS: Date I ! Account out: v D Date 1 ( t / 0Z <br /> 1.0.0.89.00 , <br />