Laserfiche WebLink
Date run 3/14/2017 2:10:48PK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report# 021 <br /> Run by Pagel <br /> Facility Information as of 3/14/2017 <br /> Record Selection Criteria: Facility to FA0023535 <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 OW0021824 New Owner ID <br /> Owner Name Lithia of Stockton <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/BusinessPhone 541-776-6401 <br /> Mailing Address 150 N Barlett St <br /> Medford, OR 97501 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0023535 10674121 <br /> Facility Name Kia Of Stockton <br /> Location 6215 Holman Rd <br /> Stockton, CA 95212 <br /> Phone 209-851-7111 x <br /> Mailing Address 6215 Holman Rd <br /> Stockton, CA 95212 <br /> Care of Dawn Branham <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 AR0043428 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Kia of Stockton (Circle One) <br /> Account Balance as of 3/14/2017: $0.00 <br /> (Circle One) <br /> Transfer to ActiveAnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owners Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO541101 EE0008709-JAMIE LIMA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO541100 EE0001459-VICKI MCCARTNEY Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ani project speck,PHSrEHD 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 andtor Standards and Stale anNw <br /> Federal Laws <br /> APPLICANTS 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 <br /> EHD Staff: �..�: Date '' / 14 / 201"1cc <br /> Aount out: Date 3 / / 17 <br /> COMMENTS: <br /> Ghar9ecZ 2220 FD 2227 Invoice#: <br /> based ovl 3/IL41201_7 ;nsPzc_hOn <br />