Laserfiche WebLink
Date run 3/4/2011 4:35:39PM SAN JOAQ-IJIN COUNTY ENVIRONMENTAL HEALTTJ DEPARTMENT Report#5021 <br /> Run by Pagel <br /> ,tom✓ Facility Information as of 3/4/201 _ <br /> Record Selection Criteria: Facility ID FA0018709 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0015377 New Owner ID <br /> Owner Name KONG, TIMOTHY <br /> Owner DBA <br /> Owner Address 1320 S VAN BUREN ST <br /> STOCKTON, CA 95206 <br /> Home Phone 209-418-3556 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1320 S VAN BUREN ST <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018709 <br /> Facility Name FORMER DOLLY MADISON <br /> Location 1426 S LINCOLN ST <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 1320 S VAN BUREN ST <br /> STOCKTON, CA 95206 <br /> Care of KONG, TIMOTHY <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16503010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name KONG, TIMOTHY <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0033213 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name STRATUS ENVIRONMENTAL INC (Circle One) <br /> Account Balance as of 3/4/2011: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name A Status New Owner? Delete <br /> 2957-UST FILE-RWQCB PR0527611 EE0000942-MAR'GWET LAGORIO 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. n` <br /> APPLICANT'S SIGNATURE: �eY \VV�e-\ 2Cal�:C-y� ���^ �^ � ate / Lk <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid �L[q _ Date / / <br /> Water System to be TRANSFERED: Amount Paid Date / ! <br /> Payment Type Check Number Received by <br /> REHS: Date ! / Account out: N Date <br /> COMMENTS: <br /> 02)4 7?-D <br /> \\eh-env\envision\reports\5021.rpt <br />