Laserfiche WebLink
Dale run 11/27/2007 2:34:50P SAN JOWIN COUNTY ENVIRONMENTAL HEA( DEPARTMENT Report#5021 <br /> Run by 5290 Pagel <br /> Facility Information'as of 11/27/2 r <br /> Record Selection Cdteda: Facility ID FA0000629 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0000504 NOwner ID <br /> Owner Name USA WASTE SERVICES, INC 7 <br /> Owner DBA MODESTO DISPOSAL SERVICE <br /> Owner-Address 8761 YOUNGER CREEK DR <br /> SACRAMENTO, CA 95828 Iv/ <br /> Home Phone Not Specified <br /> Work/Business Phone 209-538-2210 <br /> Mailing Address 2769 W HATCH RD 3U LoltaWa <br /> SACRAMENTO, CA 95828 LLt(, GA X15 0 1 - 9573 <br /> Care of USA WASTE SERVICES, IN <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000629 <br /> Facility Name CAL STATE REN LS INC <br /> Location 2769 W HATCH RD -73p LhAALWq W <br /> MODESTO, CA 95358 Al"W g.tAr CA &7&5ol— g575 <br /> Phone 209-538-8919 <br /> Mailing Address 2769 W HATCH RD X30 Ld1d.[. zJbfL./ Wa,t./ <br /> MODESTO, CA 95358 411L)a L4" CA 9s 3o I -- <br /> Care of THOM CLARK <br /> Location Code 98-OUT OF COUNTY APN: <br /> BOIS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000628 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CAL STATE RENTALS INC (Circle One) <br /> Account Balance as of 11/27/2007: $621.00 <br /> (Circle One) <br /> Transfer to Activellnaclve <br /> PrograMElement and Description Record ID Employee ID and Name Stahrs New Owner? Delete <br /> 4244-PUMPER TRUCK PR0420138 EE0004045-TED TASIOPOULOS Inactive Y N A I D <br /> 4244-PUMPER TRUCK PR0420139 EE0009374-LARRY GODINHO Inactive Y N A I D <br /> 4244-PUMPER TRUCK PR0506470 EE0009374-LARRY GODINHO Inactive Y N A I D <br /> 4244-PUMPER TRUCK PR0526631 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> 4255-CHEMICAL TOILETS PR0420137 EE0004045-TED TASIOPOULOS 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 Lewis. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: 1, Date IL_/3.7 <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />