Laserfiche WebLink
Report#5021 <br /> Date run 4/8/2004 11:34:20AM SAN JO UIN COUNTY ENVIRONMENTAL HEA1 DEPARTMENT <br /> Pagel <br /> Run by 4 Facility Information as of 4/8/20 <br /> Record Selection Criteria: Facility ID FA0012756 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION New Owner ID <br /> Owner ID OW0009938 <br /> Owner Name ELKS LODGE <br /> Owner DBA <br /> Owner Address 317 S CENTER <br /> STOCKTON, CA 95202 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 317 S CENTER <br /> STOCKTON, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Site Mitigation Facility <br /> Facility ID FA0012756 <br /> Facility Name ELKS LODGE PROPERTY <br /> Location 317 S CENTER <br /> STOCKTON, CA 95202 <br /> Phone <br /> Mailing Address 317 S CENTER <br /> STOCKTON, CA 95202 <br /> Care of APN: <br /> Location Code SIC Code: <br /> BOS District <br /> ACCOUNTS RECEIVABLE FILE INFORMATION New Account ID: <br /> Account ID AR0021321 Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Account C 6T (Circle One) <br /> Account Name HERTN KE� `�Fl?P Ulc r' <br /> )'1�Pipe R� ( (Circle One) <br /> Account Balance as of 4/8/2004: $0.00 � ^ , [� (/quM` Transfer to Active/Inactve <br /> GG//yy p V u W"' New Owner? Delete <br /> Record ID <br /> Employee Id�ame �v p R I Status <br /> Program/Element and Description NA 408CWe- Y N I D <br /> 2950-ENVIRON ASSESS PR0516724 EE900O�B <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: <br /> as the OWundersigned NER NER on this owner I also certify that all operations kwilbe performed n accorge that all site, ddanPe with alroject l applicable/OHd race Codes and/or Stalndardstandis <br /> facility or activity will be billed to the party <br /> State and/or Federal Laws. <br /> Date <br /> APPLICANT'S SIGNATURE: <br /> $ <br /> 20.00= Amount Paid Date <br /> Program Records to be TRANSFERED: Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= <br /> Check Number Rec v b <br /> Payment Type Date <br /> REHS: <br /> Date / / Account out: <br /> COMMENTS: <br /> Lo ,,I I gq 53 <br /> \\Phs-ehsq I-nt\apps\Envisions\Reports\5021.rpt <br />