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Date run 1 V412003 11:18:00AI SAN JO�tJIN COUNTY ENVIRONMENTAL HEAbvtl DEPARTMENT Repan#5021Pagel <br /> Run by Facility Information as of 11/4/2003 <br /> Record Selection Criteria: Facility to FA0013994 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0003724 New Owner ID <br /> Owner Name BANK OF STOCKTON <br /> Owner DBA <br /> Owner Address PO BOX 1110 <br /> STOCKTON, CA 95201 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-941-1444 <br /> Mailing Address PO BOX 1110 <br /> STOCKTON, CA 95201 <br /> Care of BANK OF STOCKTON <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013994 <br /> Facility Name MONTE VISTA <br /> Location S STANISLAUS ST <br /> STOCKTON, CA 95202 <br /> Phone 209-929-1200 <br /> Mailing Address S STANISLAUS ST <br /> STOCKTON, CA 95202 <br /> Care of CHARLES HALDIN <br /> Location Code 01 - STOCKTON APN:149-200-10 <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0023681 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name COND EA ECHNOLOGIES, INC (Circle one) <br /> Account Balance as of 111412003: $-26.70 7 -z� <br /> + T 4. <br /> (Circle One) <br /> Transfer to <br /> Activellnactve <br /> Pro ram/Element and Description Record ID Employee New Owner? Delete <br /> Program/Element p p yee ID and Name Status <br /> 2950-ENVIRON ASSESS PR0518598 EE0000684-MICHAEL INFURNA ive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER an this form. I also certify that all operations will be performed in accordance with all applicable Ordinaco Codes andlor Standards and <br /> State andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date ! / <br /> Water System to be TRANSF RED: '$155.00= Amount Paid Date ! 1 <br /> Payment Type Check Number Received by <br /> REHS: Date 1 I Account out: Date 1 ! <br /> COMMENTS: <br /> 11Phs-ehsql-ntlapps\Envisions\Reports15021.rpt�� `� <br />