Laserfiche WebLink
Date run 2/22/2011 11:56:38AI SAN JOACOUNTY ENVIRONMENTAL HEALTSEPARTMENT Report#5021 <br /> Run by & Pagel <br /> Facility Information as of 2122/2011 <br /> Record Selection Criteria: Facility ID FA0015622 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0012568 New Owner ID : <br /> Owner Name PE2TENTH <br /> 5ST <br /> EROS,GLORIA n C r-'Q✓1D <br /> Owner DBA DS INC _� o a rh <br /> Owner Address 18I.J. Tr--¢m eyl <br /> STS- tac��or� CA gSZ <br /> Home Phone 20 ! n / 2 e3 1 <br /> Work/Business Phone 20 <br /> Mailing Address 18 <br /> STOCKTON, CA 95206 S t o _rA 'T S"L{ <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015622 <br /> Facility Name DSJ CUSTO :4:eBINETS INC .e <br /> Location 4843 E F INT 'i-3 r <br /> STOC ON, CA 95215 <br /> Phone 209-547-1754 <br /> Mailing Address 1844 E TENTH STs <br /> +Y�s'c <br /> STOCKTON, CA 95206 41; 4; 7 1�5 <br /> Care of GLORIA BALLES OS <br /> Location Code 99- UNIN ORATED P Alt Phone <br /> BOS District 00 HSTALLER, LARRY Fax <br /> APN 14328024 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DAVID P EZ <br /> Title <br /> 09-5175Day Phone 20 4 <br /> Night Phone 23 <br /> Gy <br /> f Ma Q n O <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026987 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name DSJ CUSTOM CABINETS INC (Circle One) <br /> Account Balance as of 2/22/2011: $262.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0523134 EE0009488-JEFFREY WONG Aotiv Y N A D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO532755 A e Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,an r project specific,PHS/EHD hourly charges associated with this <br /> facility 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 Ordinam Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: � Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date /_/ <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: Date / /_ Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />