Laserfiche WebLink
Date ran 2/22/2006 8:53:49AK SAN JUIN COUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Run by 4006 Pagel <br /> Facility Information as of 2/22/2 <br /> Record Selection CrHg'ia: Facility ID FA0015684 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0012626 New Owner ID <br /> Owner Name LEACH, CLIFF <br /> Owner DBA WRENCHERS/CLIFF LEACH#31 <br /> Owner Address 16 N AMERICAN ST APT 108 <br /> STOCKTON, CA 95202 <br /> Home Phone 209-518-8802 <br /> Work/Business Phone Not Specified <br /> Mailing Address 16 N AMERICAN ST APT#108 <br /> STOCKTON, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015684 <br /> Facility Name WRENCHERS/CLIFF LEACH#31 <br /> Location 819 E FREMONT ST STE 31 <br /> STOCKTON, CA 95202 <br /> Phone 209-518-8802 <br /> Mailing Address 819 E FREMONT ST STE#31 <br /> STOCKTON, CA 95202 <br /> Care of LEACH, CLIFF <br /> Location Code 01 -STOCKTON APN: <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027142 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility ! Account <br /> Account Name WREN LEACH#31 (ClydeOne) <br /> Account Balance as of 2/22/20 $$1,072.00 '�4.2-4 — -"oq �p��Fc7p,OS <br /> 4 Lys ZOOS (Circle One) <br /> `Y l Transfer to Acgretlnac{ve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owne l Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO523222 EE0008373-JOHN JACKSON Active Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges asso t ith this <br /> facility or activity will be billed to the party Identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Stan ards and <br /> State and/or Federal Laws. '. �• \ ,/�1'1 <br /> APPLICANTS SIGNATURE: Date <br /> I <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Receiv <br /> REHS: Date / / Account out: Date / / <br /> COMMENTS: <br /> Sl Lxt� LJd T✓�Z� ?VOL <br /> n� S]...a-c{ 0 2 /��c� 71 �'t S7i L A�0^5 zs.S <br /> YhA-t 0M.'�-- Q Lk Nth �L1-1 o L4) N) <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt /\S.I ,C 0 I/ I' � <br /> !"1 SJ V W l 1 1 �� ca l <br />