Laserfiche WebLink
Date run 7/27/2009 2:41:14PN SAN JO,_,UIN COUNTY ENVIRONMENTAL HEAL.-A DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/27/2009 <br /> Record Selection Criteria: Facility ID FA0019834 <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 OW0016274 New Owner ID <br /> Owner Name EBM INVESTMENTS, A CA GEN PART <br /> Owner DBA <br /> Owner Address 9221 HAZEN DR <br /> BEVERLY HILLS, CA 90210 <br /> Home Phone 310-277-0456 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1875 CENTURY PARK EAST#1840 <br /> LOS ANGELES, CA 90067 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019834 <br /> Facility Name CVS PHARMACY#75831 <br /> Location 6632 PACIFIC AVE <br /> STOCKTON, CA 952073720 <br /> Phone <br /> Mailing Address 1875 CENTURY PARK EAST#1840 <br /> LOS ANGELES, CA 96007 <br /> Care of EBM INVESTMENTS A CA GEN PRTNR <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 08126020 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0035305 New Account ID: <br /> Mail Invoices to Account , Mail Invoices to: Owner / Facility / Account <br /> Account Name SHAW ENVIRONMENTAL (Circle One) <br /> Account Balance as of 7/27/2009: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0530340 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,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 ! / <br /> COMMENTS: <br /> \\eh-env\e nvi s ion\reports\5021.rpt <br />