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Date run 5/3/2005 3:05:56PM SANJ IN COUNTY ENVIRONMENTAL HEAO DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/3/2005 <br /> Record Selection Criteria: Facility ID FA0016052 <br /> Make changestcorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <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 500 S BECKMAN RD <br /> LODI, CA 95240 <br /> Phone 209-339-7200 <br /> Mailing Address PO BOX 2458 <br /> LODI, CA 95241 <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 AccountlD: : <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CLAYTO 0 SERVICES (Circle One) <br /> Account Balance as of 5/3/2005: -401.00 /1 O� <br /> f ` � (Circle <br /> `— y,j"L�,•.�p//� Transfer to qct: Inl <br /> Program/Element and Description Record ID EmployeC ID and Name Status New Owner? <br /> 2950-ENVIRON ASSESS PR0523834 EE0000684-MICHAEL INFURNA Ac' e Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and r project speck,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 /> Stale and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRA SFERED: '$155.00= Amount Paid Date <br /> Payment Typ Check Number Received by <br /> 05RENS: Date / 3 / Account out: Date <br /> COMMENTS: <br /> ,alt s ze o <br /> \\phs-ehsgl-nt\apps\envisio ns\repons\5021.rpt <br />