Laserfiche WebLink
Date run 212/2009 2:44:29PM SAN J06IN COUNTY ENVIRONMENTAL HEADEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/2/20 <br /> Record Selection Criteria: Facility ID FA0019235 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013472 New Owner ID <br /> Owner Name VALDEZ, EUGENIA DUARTE <br /> Owner DBA J & L <br /> Owner Address 3253 S EL DORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Home Phone 209-941-2216 <br /> Work/Business Phone 209-982-5084 <br /> Mailing Address PO BOX 238 <br /> FRENCH CAMP, CA 95231 <br /> Care of VALDEZ, EUGENIA D <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019235 <br /> Facility Name J & L MARKET <br /> Location 8125 S EL DORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Phone <br /> Mailing Address PO BOX 238 <br /> FRENCH CAMP, CA 95231 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 001 -GUTIERREZ, STEVE Fax <br /> APN 19317003 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AccountlD AR0034223 New Account ID: : <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ATC ASSOCIATES INC (Circle One) <br /> Account Balance as of 2/2/2009: $630.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer' Delete <br /> 2957-UST FILE-RWQCB PR0528611 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,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 /> State 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 TRANSFERED: "$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />