Laserfiche WebLink
Runby : NORA San Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 01/05/99 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): <br /> OWNERSHIP CHANGE (date): <br /> OWNER ID: 006593 New Owner ID: p00 1 n <br /> Owner Name: !^Yo55 JGnM C bW�N.�LUM.T`i 1=Ltl ��2V'�� <br /> Owner DBA: <br /> owner Address: 2140 PROFESSIONAL DR 200 <br /> ROSEVILLE, CA 95661 <br /> Home Phone: <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 2140 PROFESSIONAL DR STE 200 I n <br /> Care of: c` <br /> ROSEVILLE, CA 95661 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007976 <br /> Facility Name: <br /> Location: EIGHTH ST & FRESNO AVE <br /> STOCKTON 95205 <br /> Phone: <br /> Mailing Address: 2140 PROFESSIONAL DR STE 200 / <br /> care of: C,ro55wK1C1k- Pow �nLnnt�( (�InL(c{ev5 <br /> ROSEVILLE, CA 95661 <br /> Location Code: 0 1 APN: <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0014807 New Account ID: 000 <br /> Mail Invoices to: z^^ lri-t 0WJ I-er Mail Invoices t . Owner / Facility / Account <br /> Account Name: BRIDGEPORT TRAILS ircLe one) <br /> Account Balance as of 01/05/99 : $101.40 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br /> 2950 ENVIRON ASSESS PR508174 6219 DUNCAN ACTIVE Y N A I D <br /> _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> - - - - - - - - - - - - - - - - - - - - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid Date—/—/— <br /> Water <br /> ate_/ /Water System to be TRANSFERED: x $150.00 = Amount Paid Date—/—/— <br /> Payment <br /> ate_/ /Payment Type Check # Recvd by <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -/- -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> REHS or COUNTER SUPV: Date /Z. / ACCT out: 1.y7J Date L /`�� UNIT/File:_/_/_ <br />