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Date run 5/14/2003 8:02:18AN SAN JUIN COUNT ENVIRONMENTAL HE DEPARTMENT Report 45021 <br /> Run by Pagel <br /> Fac lity Information as of 5/14/2 <br /> Record Selection Cited <br /> a: Facility ID FA0012765 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0009945 New Owner ID <br /> Owner Name FRANCO, BOB/OLIVAREZ, IV ICHAEL <br /> Owner DBA MERCY CHARITIES <br /> Owner Address 7406 WOODSIDE <br /> STOCKTON, CA 95207 <br /> Home Phone 209-466-8225 <br /> Work/Business Phone 209-466-4953 <br /> Mailing Address 7406 WOODSIDE <br /> STOCKTON, CA 95207 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012765 <br /> Facility Name GLEASON PARK PROPERTI S <br /> Location CALIFORNIA ST <br /> STOCKTON, CA 95203 <br /> Phone 209-937-8811 <br /> Mailing Address 305 N ELDORADO STE 200 <br /> STOCKTON, CA 95202 <br /> Care Of KITTY WALKER/CITY OF STOCKTON <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021341 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name GLEASOKPROPERTIES circle Ore) <br /> Account Balance as of 5/14/2003 $0.00 <br /> (Circle O <br /> Transfer to Aotiv native <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? D <br /> 2950-ENVIRON ASSESS PR0516739 EE0000684-MICHAEL INFURNA Active Y N A I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project speck,PHS/EHD hourly charges associated I his <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 Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Type Check Number R reilpetl/b / <br /> REHS: Date_./ / Account out: <br /> COMMENTS: <br /> %kPhs-ehsq I-nt\apps\Envisions\Reports\5021.rpt <br />