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Date run 1/10/2005 3:30:31PN SAN JC UIN COUNTY fENVI�ONMENTAL HEi H DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility information as of 1/10/2005 <br /> Record Selection Criteria: Facility ID FA0015447 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0012402 New Owner ID <br /> Owner Name CORT, DANIEL <br /> Owner DBA CDS INVESTORS PARTNERSHIP <br /> Owner Address 343 E MAIN ST <br /> STOCKTON, CA 95202 <br /> Home Phone 209-235-5231 <br /> Work/Business Phone Not Specified <br /> Mailing Address 343 E MAIN ST <br /> STOCKTON, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION L <br /> Facility ID FA0015447 �GL/ <br /> Facility Name STOCKTON ROYAL THEATRE <br /> Location 1825 PACIFIC AVE <br /> STOCKTON, CA 95204 <br /> Phone <br /> Mailing Address 1825 PACIFIC AVE <br /> STOCKTON, CA 95204 <br /> Care of DANIEL CORT <br /> Location Code 01 - STOCKTON APN:13702042 <br /> BOS District 002 - MARENCO, DARIO SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026653 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name STOIC ON WOR HIP CENTER (Circle One) <br /> Account Balance as of 1/10/200 : $767.25 <br /> (Circlene) <br /> Transfer to Acti /Inactve <br /> New Owner? De e e <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2950-ENVIRON ASSESS PR0522666 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,t e undersigned owner,operator or agent of same,acknowledge that all site,and/o(project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the WNER 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 TRANSSFERED: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: Date g Account out: Date <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />