Laserfiche WebLink
Date run 2/2/2018 2:33:35PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 05021 <br /> Run by Pagel <br /> Facility Information as of 2/2!2018 <br /> Record selection Criteria: Facility ID FACO24140 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0022659 New Owner ID <br /> Owner Name MIKE SELEY <br /> Owner DBA <br /> Owner Address 1515 HOPE ST <br /> S PASADENA, CA 91030 <br /> Home Phone 415-640-2261 <br /> Work/Business Phone 626-799-1196 <br /> Mailing Address 1515 Hope St. <br /> South Pasadena, CA 91030 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0024140 10740295 <br /> Facility Name FRENCH OILS LLC <br /> Location 9240 S Harlan Rd <br /> French Camp, CA 95231 <br /> Phone 209-561-9114 x <br /> Mailing Address 9240 S.HARLAN RD <br /> FRENCH CAMP, CA 95231 <br /> Care of French Oils <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0044858 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name KAREN DALLAS � (Circle one) <br /> Account Balance as of 2/2/2018: $Tt64-79--- �.r ^� Z�� Teo S <br /> (Circle One) <br /> Transfer to ActiveJlnactve <br /> Program/Element and Description Record 10 Employee ID and Name Status New OwneR Delete <br /> 1921 -HMBP-Regular-Primary Location PR0542045✓ EE0000006-HAZA SAEED Active Y N AD <br /> 2220-SM HW GEN<5 TONSNR PRO542110 EE9999996-THREE VACANT3 Active Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this facility <br /> 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 Ordinance Codes and'or Standards and State andbr <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 R ived by <br /> EHD Staff: Date / / Account out: Date / /� <br /> COMMENTS: Invoice#: <br />