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1/2003 10:00 4640138 ENVIRONMENTAL HEALTH PAGE 02 <br /> DA, V32M3 9:41:18AM SAN X LIN COUNTY F, _ <br /> Ran by `2 NYII20NMENTAL HE4 H DEPARTMENT Pagel sbzt <br /> Facility Information as of 4/3/2003 Pagel <br /> Record Saleftn Craena: Fadlity ID FA0009869 1 <br /> Make changes/convictions In RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) _/-S- 99 <br /> OWNER FILE INFORMATION <br /> Owner ID OW0007869 Case Number: H05686 New Owner ID : <br /> Owner Name GEORGEBETKER/DANIEL CLARK VINCENT VtGTDRiNc <br /> Owner DBA JM EQUIPMENT CO INC <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 2,1-0E+_19 <br /> Mailing Address 1245 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Care of - <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009869 <br /> Facility Name JM EQUIPMENT CO INC <br /> Location 1245 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-466-0707 <br /> Mailing Address 1245 W CHARTER WAY <br /> STOCKTON. CA 95206 <br /> Care of <br /> Location Code 01 - STOCKTON APN:163-230-34-5 <br /> SOS District 001 -GUTIERREZ, STEVE SIC Code 9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016869 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name GEORGE BETKERIDANIEL CLARK (Circle()no) <br /> Account Balance as of 4/3/2003: $577.50 <br /> (circle ON) <br /> Transfer to Ad"AnscNe <br /> Progrom/Elemene ane Deatt'ptlon Record ID Empbyml ID ane Name stabs Naw 0~ Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO514071 EL0008844-DINA ABATE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO512157 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO520938 Active Y N A I D <br /> 2399.UNIFIED PROGRAM FAC STATE SERVICE FPRO509869 EEOOOODOO-HAZ MAT SJC DES Inactive Y N A I D <br /> BILLING end COMPLIANCE ACKNOWLEDGEMENT: 1,the undertdpned owns.operator or?gent of same,ackroMedge mat ae site,and/or project apeclec,PHSMHD houry charges aesodaled with this <br /> facthy,or activity will be billed to the party Identified as the OWNER on thla form. I also certify that all operations we be performed In=ordence with all apollcoble Ordinpee Cores and/or Standards and <br /> Sate and/or Federal L-aws. <br /> APPLICANT'S SIGNATURE: GJ-D Date 197 f'4 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Mate_/ / <br /> Payment Type Check Number d by <br /> REHS: Date I_l` Account out: Date <br /> COMMENTS: <br /> \1Phs-ehKI-n tlapprlEnvlslons\Reporfs15021.rpt <br />