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Date run 3/31/2008 8:05:04AR SAN J1137"VIN COUNTY ENVIRONMENTAL HEAT -'J DEPARTMENT Report#5021 <br /> Run by,..' -. � Pagel <br /> Facility Information as of 3/3112008 <br /> Record Selection Criteria: Facility ID FA0018020 <br /> Make changesicorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0014797 New O ner ID : <br /> Owner Name 1 WASHINGTON, T kAje!Z fZ QS17 <br /> Owner DBA SEPTIC BROTHERS <br /> Owner Address <br /> Home Phone �w <br /> Work/Business Phone x� s - }/J lL <br /> Mailing Address <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018020d����7—oZ�37 <br /> Facility Name SEPTIC BROTHERS <br /> Location c N S 7>2,�Rho <br /> .STLI 0-if-T-0 Ai t G-t- 95,22-07 <br /> Mailing Address 922 COACH ST <br /> STOCKTON, CA 95209 <br /> Care of TWASHINGTON�r - <br /> Location Code 99 _ UNINCORPORATED AREA APM05530048 <br /> BOS District 004-VOGEL, KEN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0031661 New Account ID <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name SEPTIC BROTHERS (Circle One) <br /> Account Balance as of 3131/2008: $0.00 <br /> T (Circle One) <br /> Transfer to <br /> Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PRO526620 EE0005944-MICHAEL ESCOTTO 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,PHSIEHD hourly charges associated w th this <br /> State or activity will be billed to the party iden[irred as the O ER on this form. I also cerci t ell operations will be performed in accordance with all applicable Ordinate Codes and for Standards and <br /> State and/or Federal Laws, <br /> APPLICANT'S SIGNATURE: '!/.e,% / �7 Date <br /> Program Records to be TRANSFERED: •$20.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: '$372.00= Amount Paid �O.t� Date 3 13 1 <br /> Payment Type Check Number Received by <br /> RENS: Date ]�! ! l-1I a Account out: Date <br /> COMMENTS: <br /> 7b <br /> 'LP L"L wt�� ���1c�v~L l� \� SN4 30 0A lit F�ALS <br /> View"DEP�TMEI+Sf <br /> llphs-ehsq I-ntlappslenvisionslreports15021.rpt <br />