Laserfiche WebLink
Date run 10/21/2002 3:02:55P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repot#5021 <br /> Run y,, Pagel <br /> Facility Information as of 10/21/2002 <br /> Record Selection Criteria: Facility ID FA0013967 <br /> � U 6 l f 6p�`? Make changeslcorrections in RED ink)r pencil. <br /> 0 ,J--� INFORMATION CHANGE date <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011052 New Owner ID <br /> Owner Name 1<141 C f7 L <br /> Owner DBA <br /> Owner Address 3333 NEW ✓E. <br /> •Ni u"YIDEE PARK, "�,�.,v1og� m.I Chu e _ C1`}" q SC.off <br /> Home Phone Not Specified (�R I lei 3 49 --7 SIJ <br /> Work/Business Phone Not Specified / <br /> Mailing Address 5 '1-;3 ✓)'L<L-n.zli..�L.�-!�, JE <br /> Lu�- 4 S-4 OR <br /> Care of �g.(Zy t 1p f3 <br /> FACILITY FILE INFORMATION <br /> FacilityID FA0013967 <br /> Facility Name yy}NSTpTd-TtRg--CO �)/✓I k C!9 L�� <br /> Location 1648 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> Phoned �g3 <br /> Mailing Address 2499 NEW HYDE PARK PTE Allo c' ':j- YAU,r. -Z -t-L k� Ave <br /> C arra t, q 5L0g( <br /> Care of <br /> Location Code 01 -STOCKTON APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0023621 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name AQQGsyE-AR-• A p R 00✓1 A4,1&i 3 r L-t Par (Circle one) <br /> Account Balance as of 10/21/2002: $0.00 I4ZLS- Rx✓z2 P e�7q-L w <br /> (Rt��9.'at <br /> 'D(.,Z) D �To 1 CA qSB/ "4`a2. x P ! (Circle One) <br /> Jv4 2A 1 Transfer to (Circle actve <br /> One) <br /> Program/Element and Description Record ID Employee ID and Name S Status New OwneR Delete <br /> 2950-ENVIRON ASSESS PRO518553 EE0000997-HARLIN KNOLL 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 with 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 Ordinate 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: '$155.00= Amount Paid Date <br /> Payment Type Check Number �-,- Received by <br /> REHS: Date 6 /�/ Account out: Date07-- <br /> COMMENTS: <br /> Vt ✓YCPir��u �ra �D <br /> Pot r4'- -b t^/J e S Fes/ <br /> f [e-ctse rrd cess (—kc 416(q <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt 0 • <br />