Laserfiche WebLink
Dye run 10/10/2008 3:23:14P SAN JOP&N COUNTY ENVIRONMENTAL HEAIEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 10/10/200 <br /> Record Selection Criteria: Facility ID FA0013996 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011075 New Owner ID <br /> Owner Name AGRIUM RETAIL <br /> Owner DBA WESTERN FARM SERVICE <br /> Owner Address 4582 S ULSTER ST 1700 <br /> DENVER, CO 80237 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 4582 S ULSTER ST STE 1700 <br /> DENVER, CO 80237 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013996 <br /> Facility Name WESTERN FARM SERVICE <br /> Location 1905 N BROADWAY <br /> STOCKTON, CA 95205 <br /> Phone <br /> Mailing Address PO BOX 5188 <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOB District Fax <br /> APN 14315004 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0023683 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name AGRIUM RETAIL DBA WESTERN FARM SERV (CirdeOne) <br /> Account Balance as of 10/10/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Indus <br /> Program/Element and Description Record ID Employee ID and Name Status New Omen Delete <br /> 2960-RWQCB SITE PR0518600 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that ail site,and/or project specific.PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: a Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paidv\�. Date / !0 <br /> Water System to be TRA"ED: `$372.00= Amount Paid Date ! ! <br /> Payment Type Check Number s 2 Z Received by PA••� <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> (,yW* IBo bi�L <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />