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Date run 9/1/2017 9:30:02AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/1/2017 <br /> Record Selection Criteria: Facility ID FA0004684 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0003583 New Owner ID <br /> Owner Name BOWLES, JOHN <br /> Owner DBA BOWLES ANIMAL HOSPITAL <br /> Owner Address 39 N HAM LN <br /> LODI, CA 95240 <br /> Home Phone 209-369-6601 <br /> Work/Business Phone Not Specified <br /> Mailing Address 39 N HAM LN <br /> LODI, CA 95240 <br /> Care of JOHN BOWLES <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0004684 <br /> Facility Name BOWLES ANIMAL HOSPITAL <br /> Location 39 N HAM LN <br /> LODI, CA 95240 <br /> Phone <br /> Mailing Address 39 N HAM LN <br /> LODI, CA 95240 <br /> Care of JOHN BOWLES <br /> Location Code 02 - LODI Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 03511006 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOHN BOWLES <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005092 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name BOWLES ANIMAL HOSPITAL (Circle One) <br /> Account Balance as of 9/1/2017: $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 /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO500190 EE9999998-ONE VACANTI Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific,PHS/EHD hourly charges associated with this facility <br /> 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 Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received b <br /> EHD Staff: � - Date m /7 Account out: Date�/ / /7 <br /> COMMENTS: <br /> _IInvoice#: <br />