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Date run A/27/2007 8:41:09AI1 SAN JOIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report i/5021 <br /> It Pagel <br /> RunbyFacility Information as of 6/27/20 <br /> Record Selection Criteria: Facility ID FA0005390 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0004231 ,, /� New Owner ID <br /> L_ <br /> Owner Name KNOWLES CA-R --- <br /> OwnerDBA KNOWLES Pf2-oAef-ry <br /> Owner Addressr"�.y0—�n^z"vr",MERL-N Z`f ZZ- (JooD it-AiLe cT <br /> Lop <br /> Home Phone Phone N �jo� 33 /-f I',,,Work/Business Phone �—. (���.,Mailing Address �� I—V boy etf OLJ�aB2LDG� tCare of t 5 - Lyf}(i L.- " O Lt t gcs <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0005390 <br /> Facility Name KNOWLES Yzp'zy <br /> Location 1140 W HAMMER LN <br /> STOCKTON, CA 9520Yq 334 30 s <br /> Phone 22009 9951 9959 /2�J <br /> Mailing Address P�U DbC 6,40 <br /> Care of TED KNOWLES <br /> Location Code 01 -STOCKTON APN:0774902T6 <br /> Bos District 002- RUHSTALLER, LARRY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005856 New Account ID: <br /> Mail Invoices to FAMlit7m Mail Invoices to: Owner / Facili / Account <br /> Account Name K,IdAf4E:ER. 07flbwN'n ZEO.O 4r1A L-'(S L S (circle One <br /> Account Balance as of 6/27/2007: $0.00 <br /> j�l — n� e2� '� (Circle One) <br /> 000n"` r J Transfer to AcOrcle One) <br /> Programflement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2 -UST FACILITY(BEFORE 1/84)-obsolete PR0502288 EE0000418-MICHAEL KITH Inactive 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 speck,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 andlor 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 Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date Z' 1��/L� ' <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />