Laserfiche WebLink
Data mn 3(7/2017 2:09:43PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report*5021 <br /> Run by Pagel <br /> Facility Information as of 3/7/2017 <br /> Record Selection Criteria: Facility ID FA0010501 <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 SSNI Fed Tax ID <br /> Owner ID OW0008501 Case Number: H08233 New Owner ID <br /> Owner Name MARTYLANE <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-745-6615 <br /> Mailing Address 13641 JOHN GLENN RD STE C <br /> APPLE VALLEY, CA 923085732 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0010501 <br /> Facility Name LANE CONCEPTS INC <br /> Location 2004 PICCOLI RD 2 <br /> STOCKTON, CA 95215 <br /> Phone 209-464-2792 <br /> Mailing Address 13641 JOHN GLENN RD STE C <br /> APPLE VALLEY, CA 923085732 <br /> Care of MARTY LANE <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 101-180-04 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MARTY LANE <br /> Title <br /> Day Phone 209-464-2792 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017501 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name LAINC (circle One) <br /> Account Balance as of 3/7/201 1.00 <br /> (Circle One) <br /> Transferto Active/Inetwe <br /> Program/Element and Description Record ID Employee ID and Name StaWs New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PRO541163 EE0000031 -ELIANNA FLORIDO Active Y N A 0 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512789 EE0000000-HAZ MAT SJC OES Inactiv[ Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510501 EEOO000o0-HAZ MAT SJC OES Inactiv( Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: i,the undersigned owner,operator or agent of same,acknowledge that all Site,ancior project speck,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the partyidensfied as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ands <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 Typ`,e Check Number Received <br /> EHD Staff: V�.I�P�/.I L A A A Date Account out: Date <br /> COMMENTS: <br /> poararn teas 5LLp/X,;-eot 4v be creaged a s ar ioa fyoice#: <br /> Favi I� P6' Yu0/)y7C M. AiVear.s tV ha.-6 beW aS' ,a_c),l/�e. <br /> p12Cl a� E f u5 to yi a-chv-e {Dr' owl�4 rayk? 151 094 <br /> Mat4�erF Ie <br /> Ti ntral ton {�,�m ��n �von✓�B �Ju3ed �/Z!o/i��� l� <br />