Laserfiche WebLink
Date run 3/9/2004 1:42.23PM SAN JCS JUIN COUNTY ENVIRONMENTAL HEA, DEPARTMENT Report#5021 <br /> Run by 'r"� Page( <br /> Facility Information as of 3/9/2004 <br /> Record Selection Criteria: Facility ID FA0016224 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0012098 New Owner ID <br /> Owner Name TREVOR, CATHERINE <br /> Owner DBA <br /> Owner Address 525 CLOUDVIEW DR <br /> WATERVILLE, CA 95076 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 525 CLOUDVIEW DR <br /> WATERVILLE, CA 95076 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015224 <br /> Facility Name TREVOR PROPERTY- UIC/SEPTIC <br /> Location 519 N PATTON AVE <br /> STOCKTON, CA 952151724 <br /> Phone <br /> Mailing Address 525 CLOUDVIEW DR <br /> WATERVILLE, CA 95076 <br /> Care of TREVOR, CATHERINE <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026155 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name TREVOR PROPERTY- UICISEPTIC (Circle One) <br /> Account Balance as of 31912004: $-280.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description f- 0x-• Record 1D Employee ID and Name Status New Owner? Delete <br /> 3030-UI CONTROL PROG SITE PR0522351 EE0000684-MICHAEL INFURNA 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,PHSIEHD 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 andlor Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I ! <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date ! ! <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date / 1 <br /> Payment Type Check Number Received by <br /> RENS: Date I I Account out: Date I I <br /> COMMENTS: <br /> 11Phs-ehsql-ntlappslEnvisionslReports15021,rpt <br />