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Lnord <br /> run11/6/2002 1:35:44PN SAN JO N COUNTY ENVIRONMENTAL HEA*EPARTMENT Report#5021 <br /> Pagel <br /> Facility Information as of 11/6/2002 <br /> ion Criteria: Facility ID FA0012833 <br /> Make changes/corrections in RED Ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002672 New Owner ID <br /> Owner Name BOBCAT CENTRAL INC <br /> Owner DBA <br /> Owner Address 1113 SHAW RD <br /> STOCKTON, CA 952154081 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-466-9631 <br /> Mailing Address 1113 SHAW RD <br /> STOCKTON, CA 952154081 <br /> Care of BOBCAT CENTRAL INC <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012833 <br /> Facility Name BOBCAT CENTRAL INC <br /> Location 1113 SHAW RD <br /> STOCKTON, CA 952154081 <br /> Phone <br /> Mailing Address 1413 SHAW RD '�6 I LD I`1 CWiDI'1 RT3 , <br /> SIDC K-I-o-v\ CA 116-2-b'5- 2-f-406 <br /> Care of BOBCAT CENTRAL INC <br /> Location Code 01 -STOCKTON APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021565 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ATC ASSOCIATES INC (Circle One) <br /> Account Balance as of 11/6/2002: $-69.60 <br /> (Circle One) <br /> Transfer to Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New 0~ Delete <br /> 2950-ENVIRON ASSESS PR0516823 EE0006219-LORI DUNCAN 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: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date ! / Account out: GjDate 2 <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />