Laserfiche WebLink
[Run <br /> ate run try 1/2014 9:05:06Ak SAN J COUNTY ENVIRONMENTAL HEAL .DEPARTMENT <br /> by XReport#5021 <br /> Facility Information as of 2/11/2014 Pagel <br /> ecord Selection Cntena: Facility ID FA0005103 <br /> Make changea/corrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner ID OW0003983 New Owner ID <br /> Owner Name AFFORDABLE FENCE COMPANY <br /> Owner DBA AFFORDABLE FENCE COMPANY <br /> Owner Address 2004 E MARIPOSA RD t ( ` 'T <br /> STOCKTON, CA 99009-9 �»Lftt�a� <br /> Home Phone Not Specified <br /> Work/Business Phone 209-649-9894 <br /> Mailing Address 2004 E MARIPOSA RD fill F: 5 r <br /> STOCKTON, CA 95205`1 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility lD/CERS ID FA0005103 10,181,733 <br /> Facility Name AFFORDABLE FENCE COMPANY <br /> Location 2004 E MARIPOSA RD <br /> STOCKTON, CA 95205 <br /> Phone 209-948-4415 x0 n <br /> Mailing Address 2004 E MARIPOSA RD <br /> STOCKTON, CA 95205 t}tic2� <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 17304038 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005548 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name AFFORDABLE FENCE COMPANY (Circle One) <br /> Account Balance as of 2/11/2014: $2,567.50 <br /> (Circle One) <br /> Program/Element and DescriptionTransfer to ActivellnacIve <br /> Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMSP-Regular-Primary Location PRO530812 EE0006044-LOWELL ALLEN - Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO501442 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533905 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror Projed speck,PHSrEHD hourly charges associated with this focality <br /> or activity will be billed to the party identified as the OWNER on this form I also cem that all operations will be Performed in accordance with all applicable ordinance Codes andbr Standards and State anG'or <br /> Federal Laws <br /> APPLICANT'S 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 Receiv [.[ <br /> REHS: Date_/_/ Account out: Date / / I <br /> COMMENTS: <br />