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Dale run 9,"0/2003 2:54:01 PN SAN Jf�IJIN COUNTY ENVIRONMENTAL HEAP c Paget <br /> DEPARTMENT Report#5021 <br /> Run byw <br /> Facility Information as of 9/3012 <br /> Record Selection Criteria: Facility ID FA0014958 <br /> CDEVEILOPMEN Make changes/comections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010549er ID <br /> Owner Name CITY OF STKN ROwner DBA <br /> Owner Address 305 N EL DORADSTOCKTON, CA <br /> Home Phone 209-937-8840 <br /> Work/Business Phone Not Specified <br /> Mailing Address 305 N EL DORADO ST <br /> STOCKTON, CA 952021997 <br /> Care of KITTY WALKER <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014958 <br /> Facility Name STOCKTON GROUP <br /> Location 504 WEBER AVE <br /> STOCKTON, CA 95202 <br /> Phone <br /> Mailing Address 305 N EL DORADO ST <br /> STOCKTON, CA 952021997 <br /> Care of CITY OF STKN REDEVELOPMENT <br /> Location Code 01 -STOCKTON 5 ��APN: <br /> BOS District r� SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION f 0"fm CR qs <br /> Account ID AR0025543 t%� U-a' New Account ID: <br /> Mail Invoices to qCC U `�� �aS3 `n kr"t^ Mail Invoices to: Owner / Facility / Account <br /> Account Na AR H�TECH 5� 1"r ��(�`'' (Circle One) <br /> Account Balance as of 9/3012003: �v.00 �Q(� <br /> (Circle One) <br /> Transfer to Aclive/Inactve <br /> —� New OwneR Delete <br /> ProgramlElemeM and Description Record ID Employee ID and Name Status <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0521982 EE0009488-JEFFREY WONG Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the un ne owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges assmiated 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 / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />