BILLING - Laserfiche WebLink

Home Browse Search

Report#5021 Date run 1/29/2014 9:37:37AR SAN JO*N COUNTY ENVIRONMENTAL HEAL'�EPARTMENT Pagel Run by Facility Information as of 1/29/2014 Record Selection Criteria: Faciiiry ID FA0003806 Make changesicorrections in RED ink. K INFORMATION CHANGE(date) OWNERSHIP CHANGE(date) �— OWNER FILE INFORMATION SSN/Fed Tax ID New Owner ID Owner 10 OW0002822 Owner Name JH SIMPSON CO owner DBA JH SIMPSON CO Owner Address 4025 CORONADO AVE STOCKTON, CA 952042344 Home Phone Not Specified Work/Business Phone 209-466-1477 Mailing Address PO BOX 8640 STOCKTON, CA 95208 Care of FACILITY FILE INFORMATION Site Mitigation Facility Facility ID/CERS ID FA0003806 10181437 Facility Name JH SIMPSON CO Location 4025 CORONADO AVE STOCKTON. CA 95204 Phone 209-466-1477 x0 Mailing Address PO BOX 8640 STOCKTON, CA 95208 Care of Alt Phone Location Code 01 -STOCKTON Fax BOS District 002- RUHSTALLER, LARRY EMail: APN 11530025 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION New Account ID: Account ID AR0003391 Mail Invoices to: Owner / Facility / Account Mail Invoices to Owner (Circle one) Account Name JH SIMPSON CO Account Balance as of 1/29/2014: $0.00 Circle one) Transfer to Activenname Program/Element and Description Record ID Employee ID and Name Status New owner? Delete Active Y N A I D 1921 -HMBP-Regular-Primary Location PR0231068 EE00000089817-ROBERT BRIGLOPEGS Inactivr Y N A I D 2361 -UST FACILITY(BEFORE 7/84)-obsolete PR0231068 EE0000008-LETITIA BRIGGS Inactivr Y N A I D ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534381 andor ro acts acific,PHSIEHD hourly charges associated with this facility BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator oragent operations same,acknowledge that all site, P 1 P or activity will be billed to the parry identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor Federal Laws. Date APPLICANT'S SIGNATURE: Amount Paid Date Program Records to be TRANSFERED: '$25.00= Amount Paid Date Water System to be TRANSFERED: Rec by Payment Type Check Number p Date / / ILIr, Date /��- Account out: -- RENS: COMMENTS: P ADb � F 2221 .