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Report#5021 <br /> DEPARTMENT Pagel <br /> Date run 4/22/2005 9:o3:toAn SAN JOAN COUNT'EN\Irmation <br /> RONMENTAL HEAL <br /> Run by 1273 Facility inas of 4/221200 <br /> Racord Selection Criteria: Fadliry ID FA0000541 <br /> Make changeslcorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION New Owner ID <br /> Owner ID OW0000443 <br /> Owner Name PACIFIC COAST PRODUCERS <br /> Owner DBA PACIFIC COAST PRODUCERS CLUFF <br /> Owner Address 631 N CLUFF <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-367-8800 <br /> Mailing Address PO BOX 880 <br /> LODI. CA 95241 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000541 <br /> Facility Name PACIFIC COAST PRODUCERS* <br /> Location 835 S STOCKTON ST <br /> LODI, CA 95240 <br /> Phone 209-334-4411 <br /> Mailing Address PO BOX 270 <br /> STOCKTON, CA 952010270 <br /> Care of APN:N/A <br /> Location Code 02-LODI SIC Code:9900 <br /> Bos District 004 -SEIGLOCK, JACK <br /> ACCOUNTS RECEIVABLE FILE INFORMATION New Account ID: <br /> Account ID AR0000540 Mail Invoices to: Owner I Facility / Account <br /> Mail Invoices to Facility (circle one) <br /> Account Name PACIFIC COAST PRODUCERS' <br /> (Circle One) <br /> Account Balance as of 4/22/2005: $0.00 Transfer to Active/lnactve <br /> Naw Owner? Delete <br /> Employee ID and Name Status <br /> PrograMElemenl and Description <br /> Record ID Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0511880 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0519753 EE0000000-HAZ MAT SJC NYAOES Inactive Y N A I <br /> 2246-RCRA GEN 25<50 TONS PR0220087 EE0008389-DENNIS CATANYAG Inactive Y N A I ✓'p''/ <br /> Inactive <br /> 2301 -UST STATE SURCHARGE FEE PR0231887 EE0008389-MICHELLE LE Y N A O D <br /> 2361 -UST FACILITY PR0231887 EE0008389-DENNIS CATANYAG Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR�PR0507252 EE0003580-MICHELLE LE Inactive <br /> or or agent <br /> f same, <br /> ge that all <br /> e,andior <br /> D hourly charges <br /> ociiated <br /> n this <br /> alLLING dl ry or activity C Will NCE to the WLEDGE.Md astheI,the <br /> OWNER on this forms I also Icerlry that all operations vrilIbe performed ntaccordance vi h all specific <br /> cable Orifi ace Codes andiorsstandards tand <br /> billied <br /> arty <br /> dentifie <br /> Stale andfor Federal Laws. <br /> Date _/—/— <br /> APPLICANTS SIGNATURE: <br /> $20.00= Amount Paid Date <br /> Program Records to be TRANSFERED: .$155.00= Amount Paid Date <br /> Water System System to be TRANSFERED: Received kill <br /> Payment Type Check Number Account o\1t: Date_r/ <br /> RENS: D Date O� <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />