Laserfiche WebLink
Date min 12/10/2013 4:33:49P SAN J01iiiiil COUNTY ENVIRONMENTAL HEAD DEPARTMENT Report05021 <br /> Run by <br /> Facility Information as of 12/10/2013 Pagel <br /> Record Selection Criteria: Facility ID FA0020604 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0016927 New Owner ID <br /> Owner Name MIRELES, RAUL C <br /> Owner DBA EL TARASCO <br /> Owner Address 3356 ZENOBIA WAY <br /> SACRAMENTO, CA 95834 <br /> Home Phone 916-798-5885 <br /> Work/Business Phone Not Specified <br /> Mailing Address 3356 ZENOBIA WAY <br /> SACRAMENTO, CA 95834 <br /> Care of MIRELES, RAUL <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0020604 <br /> Facility Name EL TARASCO <br /> Location 5151 'FC1C1 L c- <br /> STOCKTON, CA 952663342 G r <br /> Phone 916-798-5885 <br /> Mailing Address 3356 ZENOBIA WAY <br /> SACRAMENTO, CA 95834 <br /> Care of RAUL MIRELES <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16913327 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name RAUL MIRELES <br /> Title <br /> Day Phone 916-798-5885 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0036896 New Account ID: <br /> Maillnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name EL TARASCO (Circle One) <br /> Account Balance as of 12/10/2013: $116.00 <br /> (Circle One) <br /> Transfer to Activellml <br /> PrograwElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1684-SWAP MEET/FLEA MKT VENDOR STAND PRO535746 EE0003474-CHANDRA OM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project specidc,PHSEHD hourly charges associated with this facility <br /> emotivity 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 ander Standards and State andor <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 Receive <br /> REHS: �Pia Date 2/ 1 V /�3 Account out Date �Z /�/ <br /> COMMENTS: <br /> �tlinr� 1�u�lt� , i� 1rca5 {rMnd Tt\64- TrZ Locution cl 6nl <br /> Vi s inCcrrrer�{-_ Y w�clP r WA\S ct} fin2 pe k tU C a \eqe- >=WCA W <br />