Laserfiche WebLink
C <br /> ateran /13/2017 1:51:42Pk SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report#5021 <br /> Facility Information as of 3/13/2017 Paget <br /> Record Selection Criteria: Facility ID FA0015357 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner lD OW0012332 New Owner ID <br /> Owner Name ADLER, STEVE M <br /> Owner DBA <br /> Owner Address 533 W TOKAY ST CIR <br /> LODI, CA 95240 <br /> Home Phone 209-663-3157 <br /> Work/Business Phone 209-224-5284 <br /> Mailing Address 533 W TOKAY ST <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0015357 10184927 <br /> Facility Name SMA AUTO BODY& PAINT <br /> Location 43 COMMERCE ST STE 102 <br /> LODI, CA 95240 <br /> Phone 209-224-5284 <br /> Mailing Address 43 COMMERCE ST#102 <br /> LODI, CA 95240 <br /> Care of ADLER, STEVE M <br /> Location Code 02 - LODI Alt Phone <br /> Bos District 004-WINN, CHARLES Fax <br /> APN 04924004 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name STEVE M ADLER <br /> Title OWNER <br /> Day Phone 209-224-5284 <br /> Night Phone 209-663-3157 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026458 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SMA AUTO BODY& PAINT (ClrcleOne) <br /> Account Balance as of 3/13/2017: $261.00 <br /> (Circle One) <br /> Transfer to <br /> ProgranvElement and Description Record ID Employee ID and Name Status New O f'Delete <br /> 2220-SM HW GEN<5 TONSNR PRO622542 EE9999998-ONE VACANTI Active N A e D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533263 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHB/EHD hourly&a associated with thisf <br /> oractivity x it be billetl to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor ands <br /> Federal Lew. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to TRANSFERED: Amount Paid Date—/—/— <br /> Payment <br /> ate / /Payment Typ Check Number Received by <br /> EHD Staff: Date / / ccount out: Date_ /��/� <br /> COMMENTS: <br /> /' 'A ^ 01)I Invoice#: <br />