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Date run 4/13/2005 1:19:12PR SAN JO UIN COUNTY. ENVIRONMENTAL HEA' —1 DEPARTMENT Report#5021 <br />Run byPagel <br />Facility Information as of 4/13/205 it --- Affillissssillillill <br />Selection Criteria: Facility ID <br />OWNER FILE INFORMATION <br />Owner ID OW0011734 <br />Owner Name JERRY BRANNON <br />Owner DBA ADVANCED TRAILER SALES & SERVI <br />Owner Address 2101 E CHARTER WAY <br />STOCKTON, CA 95205 <br />Home Phone Not Specified <br />Work/Business Phone 209-993-3604 <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />New Owner ID : <br />Mailing Address 2101 E CHARTER WAY <br />STOCKTON, CA 95205 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID FA0014723 <br />Facility Name ADVANCED TRAILER SALES & SERVICE <br />Location 2101 E CHARTER WAY <br />STOCKTON, CA 95205 <br />Phone 209-946-0450 <br />Mailing Address 2101 E CHARTER WAY <br />STOCKTON, CA 95205 <br />Care of <br />Location Code SQA,, APN: 15-5'1 t{. o Ca <br />BOS District 00 1 SIC Code:9900 <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID ARD025030 New Account ID: <br />Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br />Account Name ADVANCED TRAILER SALES & SERVICE (Circle One) <br />Account Balance as of 4/13/2005: $0.00 <br />(circle Ona) <br />Transfer to Active/Inactve <br />Pmgram/Element and Description Record ID Employee ID and Name Status New OwoerF Delete <br />2244 - PACT TRANSFER RECORD - OES PR0521649 EE0000000 - HAZ MAT SJC DES Active Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned oymee operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly charges assmialed With this <br />facility directivity volt be billed! to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance mlh all applicable Ordinace Codes andlor Standards am <br />State and/or Federal Laws, <br />APPLICANT'S 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: Dale // Account out: Date <br />COMMENTS: <br />f4ASC 54weil <br />\\phs-ehsq I-nt\apps\envisions\reports\5021. rpt a�b <br />