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I <br /> Date nm 11/19/2010 8:26:49AI SAN JOAN COUNTY ENVIRONMENTAL HEALT�PARTMENT Repon#5021 <br /> Run by Paget <br /> Facility Information as of 11/19/2010 <br /> Record Selection Criteria: Facility ID FA0003147 <br /> { Make chanr`Icorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> M OWNERSHIP CHANGE(date) <br /> S OWNER FILE INFORMATION SSN/Fed Tax ID : 1'~ 4 3 3 04 Sr 2- <br /> i Owner ID OW 0002348 New Owner ID : <br /> F Owner Name SILVA, RTONY ou. R Sit vt, /h,C <br /> k Owner DBA SILVA, R TONY a iu 4 14 oa, INC <br /> Owner Address 5152 W GRANT LINE RD <br /> TRACY, CA 95304 <br /> Home Phone Not Specified rJaxis <br /> Work/Business Phone 209-835-3895 <br /> Mailing Address"5152 W GRANT LINE RD <br /> TRACY, CA 95304 <br /> Careof SILVA, R TONY <br /> r FACILITY-FILE INFORMATION <br /> Facility ID FA0003147 <br /> Facility Name SILVA, R TONY o AJ u q I n►C <br /> Location 5152 W GRANT LINE RD <br /> TRACY, CA 95304 <br /> Phone 209-835-3895 <br /> Mailing Address 5152 W GRANTLINE RD <br /> TRACY, CA 95304 <br /> Care of SILVA, R TONY <br /> Location Code 99- UNINCORPORATED f Alt Phone <br /> SOS District 005-ORNELLAS, LEROY Fax <br /> APN 25009001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> ` Contact Name SILVA, R TONY G e r S 1 L o 4 <br /> Title <br /> Day Phone 209-835-3895 <br /> Night Phone 209-835-3895 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> I Account ID AR0002713 NewAccount iD: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SILVA, R TONY (ClydeOne) <br /> Apppunt Balance..as.of,11./1.91.201.0:–$0.00 ...—„,--- <br /> (Circle One) <br /> Transfer to Adlve/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status WNOwner? Delete <br /> 4244-PUMPER TRUCK PR0420036 EE0004045-TED TASIOPOU LOS Active N A I D <br /> 4246-PUMPER YARD PR0420057 EE0004045-TED TASIOPOULOS Active N A I D <br /> BILLING and COMPLANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific.PHSIEHD hourly charges associated with this <br /> III 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 Ordinate Codes and/or Standards and <br /> State and/or Federal taws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFER ED: ”$25.00= Amount Paid Date / 1 <br /> Water System to be TRANSFERED: Amount Paid Date I ! <br /> { Payment ck Number Rec ' by ��� <br /> REH Date tel l Account out: Date t 1 W <br /> COMMENTS: <br /> OWE lV �o <br /> Amur N JAN 18 2011 <br /> 1 f 07.'o o ENVIRONMENTAL HEALTH <br /> 1f1 PERMITISERVICES <br /> lleh-envlenvislonVeports15021.rpt <br />