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Date run 5/24/2005 3:27:02PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by 5290 Pagel <br /> Facility Information as of 5/24/2005 <br /> Record Selection Criteria: Facility ID FA0015361 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008051 Case Number: H06370 New Owner ID <br /> Owner Name RICE, MEL <br /> Owner DBA RICE TERMINALS <br /> Owner Address 6055 RAYMOND CT <br /> STOCKTON, CA 95212 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-931-4646 <br /> Mailing Address PO BOX 680 <br /> LOCKEFORD, CA 952370658 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0015361 <br /> Facility Name RICE TERMINALS <br /> Location WEST END PORT RD A <br /> STOCKTON, CA 95212 <br /> Phone 209-931-4984 <br /> Mailing Address 6055 RAYMOND CT <br /> STOCKTON, CA 95212 <br /> Care of RICE, MEL <br /> Location Code 01 -STOCKTON APN: <br /> BOS District SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026 2 ' New Account ID: <br /> Mail Invoices to Unt Mail Invoices to: Owner / Facility / Account <br /> Account Name INTERNATIONAL RAW MATERIALS (Circle One) <br /> Account Balance as of 5/24/2005: $186.00 <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 PR0522547 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 b T SFERED: "$155.00= Amount Paid Date <br /> Payment Type Check Number Receive y <br /> REHS: Date / 2 /_ Account out: Date /a / <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envision s\reports\5021.rpt <br />