Laserfiche WebLink
Ah <br /> Date run : 8/4/00 9:49:54AM JDA AQUIN COUNTY PUBLIC HEALiMEIZ CESReport u: 0002 <br /> Run by NPERALTA Facility Information as of 8/4/00 6 <br /> Page #: 1 <br /> Record Selection Criteria: Facility ID FA0004574 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID; OW0003476 New Owner ID <br /> Owner Name; Q L'L l C lQ e. -t-r' <br /> Owner DBA; Val r wGRETr= INC _(pggo, 6ycVedl50V1 I u <br /> Owner Address; FW M,l ,14t C g4439-348s <br /> STOCKTON, CA 95206- <br /> Home Phone; 209-466-3156 �61 U) 1-P q 0 - 4 b 7 D <br /> Work/Bussness Phone; 209-466-3156 <br /> Mailing Address: 819 S STANISLAUS <br /> STOCKTON, CA 95206- <br /> Care of: VALLEY CRETE INC <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0004574 <br /> Facility Name: -Off}GP -CTZET`E t! ckt C R-t' f f <br /> Location; 819 S STANISLAUS ST <br /> STOCKTON, CA 95206 <br /> Phone: 209-466 3Y5$' 1 fbcl-L4 qq Q <br /> Mailing Address: LA T (v%!50 s rvevlso t/) 6(vd <br /> X206- ✓eyK 0V -t- c14S3R'- a 4TS7 <br /> Care of ve i i E*G — <br /> Location code: 01 - STOCKTON APN; <br /> BOS District: 001 -GUTIERREZ, STEVE SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0004359 New Account ID:: <br /> Mail Invoices to; Facility Mail Invoices to: Owner/ Facility/Account <br /> Account Name; QUICK CRETE (Circle One) <br /> Account Balance as of 8/4/00: $10.00 <br /> (Circle One) <br /> UST(s) Transferto Active/Inacty <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2381 -UST FACILITY(BEFORE 1/84) PR0231009 EE0000008-BRIGGS Inactive Y N <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE F PRO510486 EE0000000-SJC DES Active Y N <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO512774 EE000o000-SJC OES Active Y N I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlorproject <br /> specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this form. I <br /> also certify that all operations will be performed in accordance with all applicable Ordinace Codes andlor Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: *$150.00= Amount Paid Date <br /> Payment Type Check Number Receipt Number Received by <br /> REHS: I Date_/ / Account out:rLip <br /> .tD�aattel 'q ! <br /> 1.0.0.89.00 <br />