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Dale run 7/15/2009 1:20:08PK SAN JOAQUIN COUNTY ENVIRONMENTAL HEA 'DEPARTMENT Report#5021 <br /> Run by 4006 Pagel <br /> Facility Information as of 7115/2t� <br /> Record Selection Criteria: Facility ID FA0015591 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW 0012538 New Owner ID <br /> owner Name DLA FED GOV <br /> Owner DBA DDJC <br /> Owner Address 25600 CHRISMAN RD <br /> TRACY, CA 95376 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 25600 CHRISMAN RD <br /> TRACY, CA 95376 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015591 <br /> Facility Name DDJC <br /> Location 25600 CHRISMAN RD <br /> TRACY, CA 95376 <br /> Phone <br /> Mailing Address 25600 CHRISMAN RD <br /> TRACY, CA 95376 <br /> Care of DDJC <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 005-ORNELLAS, LEROY Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DDJC <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026921 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner ! Facility / Account <br /> Account Name TABER (Circle One) <br /> Account Balance as of 7/15/2009: $0.00 (Circle One) <br /> Transfer to Active/Inactve <br /> PmgmmlElement and Description cord ID Employee ID antl Name Status New Omer? Delete <br /> 2960-RWQCB SITE PR0523095 E000o997-HARLIN KNOLL Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the un reigned owner,o for or agent of same,acknowledge that all site,and/or project spec.PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party Idemfied as the OWNE I also certify that all operations will be performed in accordance with all applicable OMinace 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 />