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EReco�dnselec,fion <br /> 7/23/2002 9t34.59Af\ SAN J� UIN COUNTY ENVIRONMLNTAL HE "H DEPARTMENT Report#5021 <br /> Paget <br /> Facility Information as of 7/23/2002 <br /> Criteria: Facility ID FA0010791 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> owner ID OW0008791 Case Number: H08756 New Owner ID <br /> Owner Name PAUL HEDGE �t4✓v �5 -�tOwJS°h `��' <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified coq) 8 3S_I SSC" <br /> Work/Business Phone 209-833-0929 <br /> Mailing Address 1229 WALL ST 1906 LO✓te {CoX CT <br /> TRACY, CA 95376 T2 4c y� CA q S 3 to <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010791 �1�F0 Sp CL�,A Lrties <br /> Facility Name AUTO SPECIALTIES <br /> Location 7918 W 11TH ST 1 9 IS '-O t t 5 3 o T <br /> TRACY, CA 953049303 T2Acy / Cd N <br /> Phone 209-833-3880 Q�Ocl) $33- 399'0 <br /> m <br /> Mailing Address 7918 W 11TH ST -191K W i t — 5T <br /> TRACY, CA 953049303 cbh 45301 <br /> Care of <br /> Location Code 99 - UNINCORPORATED AREA APN: <br /> BOS District 005 - BEDFORD, LYNN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017791 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner Fatality Account <br /> Account Name AUTO SPECIALTIES °Bl <br /> Account Balance as of 7/23/2002: $0.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> New Owner'. Delete <br /> PrograMElament and Description Record ID Employee ID and Name Status <br /> 2220-SM HW GEN<5 TONS/YR PRO514419 EE0000451 -STEVE SASSON Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0513079 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0510791 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to Me party identified as he OWNER on his form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes anNor Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$20.00= Amount Paid 6& •D D Date / b�-- <br /> Water System to be TRANSFERED: `$155.00= Amount Paid Date <br /> Payment Type S t'E' Check Number ed by <br /> RENS: Date / / Account out: Date�zl1f1� <br /> COMMENTS: <br /> a� 32002 <br /> o2°asit aN�E\\s\oN <br /> pN6y\GFN.�\ NF p1S <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt ENNRONM <br />