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Date run 10/31/2018 3:36:14P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 10/31/2018 <br />Record Selection Criteria: Facility ID FA0016697 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0013538 <br />Owner Name <br />GEORGE PERRY & SONS INC <br />Owner DBA <br />GEORGE PERRY & SONS INC <br />OwnerAddress <br />164 S GRANT AVE <br />MANTECA, CA 95336 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />PO BOX 2588 <br />MANTECA, CA 95336 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0016697 10185257 <br />Facility Name <br />GEORGE PERRY & SONS INC <br />Location <br />1741 W MATHEWS RD <br />FRENCH CAMP, CA 95231 <br />Phone <br />209-234-1202 x0 <br />Mailing Address PO BOX 2588 <br />MANTECA, CA 95336 <br />Care of <br />Location Code 99 - UNINCORPORATED A <br />BOS District 001 - VILLAPUDUA, MIGUEL <br />APN 19130003 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0029579 <br />Mail Invoices to Owner <br />Account Name GEORGE PERRY & SONS INC <br />Account Balance as of 10/31/2018: $101.00 <br />Make changestcorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />1 `3lCJ() <br />MWS CA emu, C l4 Qt C 'S <br />Alt Phone <br />Fax <br />EMail : <br />Program/Element and Description Record ID Employee ID and Name <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Owner? Delete <br />1958 - HM -Farm Operations PR0524882 EE0002670 - MUNIAPPA NAIDU Active Y N A I D <br />2830 -AST FAC - SPCC EXEMPT PR0530654 EE0001459 - VICKI MCCARTNEY Inactive Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI PR0531975 Inactive Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT. I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly charges associated with this facility <br />or activity will 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 Ordinance Codes and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: " $25.00 = <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: CiDate J <br />COMMENTS: <br />Date <br />Amount Paid Date / / <br />Amount Paid Date / / <br />Received y <br />3 i / Account out: Date / <br />11`M_ 1i��ll�1 Invoice#: <br />