Laserfiche WebLink
Date run 9/3/2004 2:12:34PM <br /> Run by SAN Jq&UIN COUNTY ENVIRONMENTAL HE <br /> DEPARTMENT Report k5021 <br /> Recom Facility ID FA0013996 <br /> Facility Information as of 9/3/2004 Paget <br /> Selection Criteria: <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) - <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) - <br /> Owner ID OW0011075 <br /> Owner Name AGRIUM RETAIL New Owner ID <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 /> Care of DENVER, CO 80237 <br /> FACILITY FILE INFORMATION <br /> FacilityID FA0013996 <br /> Facility Name WESTERN FARM SERVICE <br /> Location 1905 N BROADWAY <br /> Phone STOCKTON, CA 95205 <br /> Mailing Address PO BOX 5188 <br /> Care of STOCKTON, CA 95205 <br /> Location Code 01 -STOCKTON <br /> BOS District APN: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION SIC Code: <br /> Account ID AR0023683 <br /> Mail Invoices to Account New Account ID: <br /> Account Name AGRIUM RETAIL DBA WESTERN FARM SERMail Invoices to: Owner / Facility / Account <br /> 6 IL <br /> Balance as of 9/3/2004: $0.00 (Circle One) <br /> V <br /> �vw'�'•lite IL4�(Iq <br /> Program/Element and Description Transfers, (Circle One) <br /> RecordID Employee ID and Name New Owner? Active/Inacive <br /> 2960-RWOCB CLEAN UP SITE(SLIC) status Delete <br /> PR0518600 EE0000684-MICHAEL INFURNA Active <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 <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or cr Federal Laws. <br /> APPLICANT'S SIGNATURE: <br /> Program Records to be TRANSFERED: '$20.00 Date <br /> = <br /> Water System to be TRANSFERED: Amount Paid Date_/ / <br /> $155.00= Amount Paid Date <br /> Payment Type Check Number <br /> REHS: Received by <br /> Date / / Account out: Date <br /> COMMENTS: / <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />