Laserfiche WebLink
Data run 10`2/2017 11:45:5V SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 05021 <br /> Run by <br /> DONNA Facility Information as of 10/12/2017 Paget <br /> Record Selection Criteria: Facility ID FA0013509 <br /> Make changestcorrections in RED ink. I <br /> INFORMATION CHANGE(date) l o h, 2 v�� <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0010638 New Owner ID <br /> Owner Name JOHN R LAWSON ROCK& OIL <br /> Owner DBA JOHN R LAWSON ROCK & OIL <br /> OwnerAddress 10848 S HARLAN <br /> FRENCH CAMP, CA 95231 <br /> Home Phone Not Specified 0 T <br /> Work/Business Phone 209-983-0951 9 <br /> Mailing Address 10848 S HARLAN RD <br /> FRENCH CAMP, CA 95231 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0013509 10184373 <br /> Facility Name JOHN R LAWSON ROCK& OIL <br /> Location 10848 S HARLAN <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-983-0951 x0 <br /> Mailing Address <br /> F 1 <br /> Care of-Brian Duncan <br /> Location Code 99-UNINCORPORATED A Alt Phone <br /> BOB District Fax <br /> APN 19333028 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022612 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name JOHN R LAWSON ROCK&OIL (Circle One) <br /> Account Balance as of 10/12/2017: $653.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP•Reclular-Primary Location PR0520898/ EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO540462 EE9999996-THREE VACANT3 Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO517578 EE9999996-THREE VACANT3 Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0517577 EE00000cO-HAZ MAT SJC DES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523781 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO534348 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specRc.PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the pony identied as the OWNER on this form. I also certify that all operations will be performetl in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> 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 Re ' b <br /> EHD Staff: [,O>m/t Date / _/mac/ Account out: Date <br /> COMMENTS: <br /> Invoice#: <br /> r e-4tia n ryxodea oLtnd lL44 no, 4vV')vcd%n5 a-A&IV 11-C-0-se (3-di <br /> 9`2✓� 4 ;/2 V0]',-4--- � &a,t mun�a� /tom �� �� uul� A� <br /> d�.ys. �y ./n <br />