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Date run 11/14/2007 8:16:27A SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by 4006 Paget <br /> Facility Information as of 11/14/2 <br /> Record Selection Clients: Facility ID FA0018452 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW 0008158 New Owner ID <br /> Owner Name BIER, WAYNE <br /> Owner DBA TRIUMPHS ONLY <br /> Owner Address 1881 E MARKET ST <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-939-1020 <br /> Mailing Address 1881 E MARKET ST <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018452 <br /> Facility Name BIER PROPERTY <br /> Location 1881 E MARKET ST <br /> STOCKTON, CA 95205 <br /> Phone <br /> Mailing Address 1881 E MARKET ST <br /> STOCKTON, CA 95205 <br /> Care of BIER WAYNE <br /> Location Code 01 -STOCKTON APN:15304003 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032601 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner I Facility I Account <br /> y (Circle One) <br /> Account Name BIER PROPERTY <br /> Account Balance as of 11/14/2007: $0.00 (Circle One) <br /> Transfer to Active/Inaclve <br /> Naw Omen Delete <br /> Program/Element and Description <br /> Record ID Employee ID and Name Status <br /> 2950-ENVIRON ASSESS <br /> PRO627249 EE0006219-LORI DUNCAN 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 vath 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 /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid �� Date / / <br /> Water System to be TRANSFERED: -*$372.00=--� Amount Paid b2- Date—V--/—L3—/—O—/— <br /> Payment Type ✓ Check Number 2 "�f' Received by 2y4i <br /> RENS: Date_/_/_ Account out: Date <br /> COMMENTS: <br /> P��GFE/FD <br /> NOV 13 2007 <br /> SA ENV RONMIE Ti <br /> �7 <br /> HEATH DEPAR <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />