Laserfiche WebLink
ag <br /> Date run 12/2312013 2',09:28P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ortlr5021 <br /> Pagel <br /> Run by <br /> Facility Information as of 12123!2013 <br /> Record Selection Crillena: Facility ID FA0005059 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID <br /> Owner ID OW0003940 New Owner ID <br /> Owner Name DELTA PACKING COMPANY OF LODI <br /> Owner DBA DELTA PACKING CO <br /> Owner Address 5950 E KETTLEMAN LN <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-321-5462 <br /> Mailing Address 6021 E KETTLEMAN LN <br /> LODI, CA 95240 <br /> Care of COSTAGMAGNA, ERNIE <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID 1 CERS ID FA0005059 10181721 <br /> Facility Name DELTA PACKING COMPANY OF LODI <br /> Location 5950 E KETTLEMAN LN <br /> LODI, CA 95240 <br /> Phone 209--33-4-10 x0 <br /> Mailing Address 6021 E KETTLEMAN LN <br /> LODI, CA 95240-640 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 06103015 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005504 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to Owner 1 Facility 1 Account <br /> Account Name DELTA PACKING COMPANY OF LODI (Cirdeone) <br /> Account Balance as of 12123!2013: $0.00 �Ciraeone) <br /> Transfer to ActiveAnacNe <br /> program/Element and Description Record ID Employee 10 and Name Status New Owner? Delete <br /> -4925 HMBP-Multisite Secondary Location PRO511558 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> '•1%2 CaIARP PROGRAM 2 FACILITY PR0529999 EE0000988 KASEY FOLEY Active Y N A 1 D <br /> 2226-CaIARP PROGRAM PRO514549 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1184)-obsolete PR0501303 EE0000451 -STEVE SASSON Inactive Y N A ! D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509270 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO535279 Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I.the undersigned owner,operator or agent of same.acAnowledge that all site_andor project specific.PHSlEHO hourty charges associated with this facdily <br /> W activay will rte billed to the party rdentdied as the OWNER on this form I also certify that all operations wolf be performed in accordance with all apPI'cQble Ordinance Codes andor Standards and State ander <br /> Federal Laws <br /> APPLICANTS SIGNATURE Date _1_/ <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date ! 1 <br /> Payment Type Check Number Received by <br /> REHS: Date 1 ! Account out: Date <br /> COMMENTS <br />