Laserfiche WebLink
Date run 7/18/2006 3:29:48PR SAN JOAN COUNTY ENVIRONMENTAL HEALT\ DEPARTMENT Reporl#5o21 <br /> Run by Pagel <br /> Facility Information as of 7!18/200 <br /> Record Selection Criteria: Facility ID FA0016052 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) —I-15 Ob <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0012962 New Owner ID <br /> Owner Name RE SERVICE CO INC <br /> Owner DBA RE SERVICE CO <br /> Owner Address 500 S BECKMAN RD <br /> LODI, CA 95240 <br /> Home Phone 209-339-7200 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 2458 <br /> LODI, CA 95241 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0016052 <br /> Facility Name RE SERVICE CO <br /> Location 588 8 BEe'EMAIIII R15 <br /> e )BI, GA-952-49 <br /> Phone 209-339-7200 <br /> Mailing Address PO BOX 2458 SMO American K''Ner OR. Ste t\z <br /> LODI, CA 95241 SaeramentO CA• 96b(o4- -5999 <br /> Care of <br /> Location Code 02 -LODI APN 04925081 <br /> BOS District 004-SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027994 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CLAYTON GROUP SERVICES (Circle One) <br /> Account Balance as of 7/18/2006: $0.00 <br /> (Circle One) <br /> Transferlo Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0523834 EE0000684-MICHAEL INFURNA Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlorproject specific,PHS/EHD hourly charges associated vnth this <br /> facility or activity will be billed to the parry identfied as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State andtor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / I <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date /_/ Account out: Date <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt • <br />