Laserfiche WebLink
Date mn 3/6/2006 2:54:31 PM SAN JUIN COUNTY ENVIRONMENTAL HEAW <br />Ron by Facility Information as of 3/6/2006 <br />Record Selection Catena: Facility ID FA0006943 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0005703 <br />Owner Name <br />PA{*FIAN-6 <br />Owner DBA <br />LATHROP CHEVRON <br />owner Address <br />140 LATHROP RD <br />Phone <br />LATHROP, CA 95330 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />..925=973= tolt <br />Mailing Address 140 E LATHROP RD <br />LATHROP, CA 95330 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0006943 <br />Facility Name <br />LATHROP CHEVRON <br />Location <br />140 E LATHROP RD <br />LATHROP, CA 95330 <br />Phone <br />209-982-5779 <br />Mailing Address <br />140 E LATHROP RD <br />A <br />LATHROP, CA 95330 <br />Care of <br />EE0000753 - WILLIE NG <br />Location Code <br />07 - LATHROP <br />SOS District <br />003 - MOW, VICTOR <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0009855 <br />Mail Invoices to Facility <br />Account Name LATHROP CHEVRON <br />Account Balance as of 3/6/2006: $0.00 <br />Report 85021 <br />Pagel <br />Make changes/corrections in RED Ink or pe cit. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />tit�DL <br />rae,., n,.,.,e, In <br /> <br />APN:19611007 <br />SIC Code:9900 <br />New Account ID::. <br />Mail Invoices to: Owner / acili / Account <br />( e one) <br />(Circle One) <br />Transfer to Active/Inactve <br />New Owner? Delete <br />program/Element and Description Record ID <br />Employee ID and Name <br />Status <br />• 1615 - RETAIL MKT <2000 SO FT (PREPKGD / LTCPRO506097 <br />EE0001699 - JOHNNY YOAKUM <br />Active <br />N <br />A <br />I D <br />* 2220 - SM HW GEN <5 TONSNR PR0518581 <br />EE0000753 - WILLIE NG <br />Active <br />Y <br />N <br />A <br />I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512906 <br />EE0000000 - HAZ MAT SJC DES <br />Inactive <br />Y <br />N <br />A <br />I D <br />2244 - PACT TRANSFER RECORD - IDES PRO520435 <br />EE0000000 - HAZ MAT SJC DES <br />Active <br />Y <br />N <br />A <br />I D <br />2301 - UST STATE SURCHARGE FEE PR0515563 <br />EE0007289-ALISON YOUNGBLOOD Inactivey, <br />N <br />A <br />I D <br />• 2361 - UST FACILITY PRO505687 <br />EE0000753 - WILLIE NG <br />Active <br />Y)N <br />A <br />I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARIPR0507640 <br />EE0007289 -ALISON YOUNGBLOODInactive <br />Y <br />N <br />A <br />I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHAR�PRO518583 <br />EE0008493 - LORI LUCES <br />Inactive <br />Y <br />N <br />A <br />I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner, operator or agent of same, semoMedge that all site, and/or project specific, PHS/EHD hourly charges assoclated with this <br />facility or activity wilt 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 Ordinate Codes andfor Standards and <br />Stale and/or Federal Laws. <br />APPLICANTS SIGNATURE: - Date 3 1-"- / b� <br />Program Records to be TRANSFERED: ' $20.00 = O•o o Amount Paid _ Date _/_/_ <br />Water System to be TRANSFERED: " $372.00 = Amount Paid Date <br />Payment Type Check Number Received by <br />RENS: �N • N �+ _ Date // Account out: <br />COMMENTS: <br />\\p hs -eh sql-nt\apps\envisions\reports\5021. rpt <br />