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Data run 2/2/2005 2:05:11PM SAN JO UIN COUNTY ENVIRONMENTAL HEA- °I DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 2/2/2005 Page <br /> Record Selection Criteria: Facility ID FA0015736 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION.CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0004892 New Owner ID <br /> Owner Name AL DEL PRETE <br /> Owner DBA MINER AVENUE PROPERTIES <br /> Owner Address 4515 HILDRETH LN <br /> STOCKTON, CA 95212 <br /> Home Phone 209-933-9212 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1950 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility Ie THERMO- / /n / n <br /> Facility Name THERMO-KING STOCKTON v— .0 <br /> Location 1950 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-933-9212 <br /> Mailing Address 1950 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Care of THERMO-KING STOCKTON <br /> Location Code APN: <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027258 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name TERRACON (Circle One) <br /> Account Balance as of 2/2/2005: $-102.30 <br /> (Circle One) <br /> Transfer to Activeltnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PRO523303 EE0000942-MARGARET IAGORIO Active Y N A \I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent all <br /> same,acknowledge or all site,accordance <br /> project specify PHS/Ond hourly chargesassociatedStanch with this <br /> facility or activity will be billed To the party identified as the OWNER on this form. I also certiy that all operations will be performed in accortlance with all applicable Ortlinacd Codes antler 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: _*$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: >✓t •9�Lt-.1 Date / i/ Account ouC (.�J Date �/ /�� <br /> COMMENTS:. <br /> a <br /> \\phschsgl-nt\apps\envisions\reports\5021.rpt <br />