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Date run 7/1/2004 8:30:07AM SAN JO `UIN COUNTY ENVIRONMENTAL HEA' 'i DEPARTMENT Report 06021 <br /> Run by / <br /> Facility Information as of 7/1/200�4 Pagel <br /> Record Selection Criteria: Facility ID FA0014614 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011630 New Owner ID <br /> Owner Name CRITES, VONNIE& PATTY <br /> Owner DBA <br /> Owner Address 36200 S CHRISMAN RD <br /> TRACY, CA 95376 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 36200 S CHRISMAN RD <br /> TRACY, CA 95376 <br /> Care of VONNIE& PATTY CRITES <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014614 <br /> Facility Name VONNIE & PATTY CRITES <br /> Location 36200 S CHRISMAN RD <br /> TRACY, CA 95376 <br /> Phone <br /> Mailing Address 36200 S CHRISMAN RD <br /> TRACY, CA 95376 <br /> Care of VONNIE &PATTY CRITES <br /> Location Code APN:26506005 <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024861 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name VONNIE& PATTY CRITES (Circle One) <br /> Account Balance as of 7/1/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Pr ram/Element and Description Record ID Employee New Owner? Delete <br /> og p� p yee ID and Name Status <br /> 2217-APPLIANCE RECYCLER PR0521525 EE0008389-DENNIS CATANYAG Active Y N A �J D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,antl/a project specific,PHS/EHD hourly 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 will be performed in accordance with all applicable Ordinace Cotler and/or Standards and <br /> Stale and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date 1../ 3J /CA Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />