Laserfiche WebLink
Date run 10/16/2009 3:37:29F SAN JOAnUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> `/ Facility Information as of 10/16/20... Pagel <br /> Record Selection Criteria: Facility ID FA0019174 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> `"` •. <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date)�x <br /> +'" SSN/Fed Tax ID <br /> Owner ID OW0011397 New Owner ID <br /> Owner Name LINCOLN PROPERTIES LTD <br /> Owner DBA LINCOLN PROPERTIES LTD <br /> Owner Address 374 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Home Phone 209-478-9200 <br /> Work/Business Phone Not Specified <br /> Mailing Address 374 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Care of BILL JOHNSON <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019174 <br /> Facility Name CHEVRON SERVICE STATION 9-6171 y`S <br /> Location 6633 PACIFIC AVE \ �p <br /> STOCKTON, CA 95207 r �� <br /> Phone 6&-- <br /> Mailing Address PO BOX 7611 f� <br /> SAN FRANCISCO, CA 94120 ` <br /> Care of LINCOLN PROPERTIES LTD <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 09741048 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOHNSON, PHIL <br /> Title <br /> Day Phone 209-478-9200 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034126 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CHEVRON-ENVIRONMENTAL MGMNT CO (Circle One) <br /> Account Balance as of 10/16/2009:/$6,26/ 50 <br /> �� (Circle One) <br /> W Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner9 Delete <br /> 2957-UST FILE-RWQCB PR0528433 EE0000684-MICHAEL INFURNA Active Y N A UI 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. <br /> APPLICANT'S 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 -2, /n <br /> COMMENTS: ¢ <br /> \\eh-env\envision\reports\5021.rpt /Vt <br /> .i <br />