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Report 10:5025 <br /> get <br /> LRun <br /> n 8/3/2011 2:07:30PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report <br /> 1273' Facility Information as of 8/3/2011 <br /> Select on Criteria: Faality ID FA000i 136 <br /> Make changesicorrections In RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID : <br /> Owner ID OW0000878 New Owner ID <br /> Owner Name PARK PLACE SERVICES <br /> Owner DBA TAHAMA VILLAGE MOBILE HOME PRK <br /> Owner Address PO BOX 1687 <br /> BELLFLOWER, CA 907071687 <br /> Home Phone Pip W _7+7 <br /> Ho T <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 1687 <br /> BELLFLOWER, CA 907071687 <br /> Care of PARK PLACE SERVICES S <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001136 <br /> Facility Name TAHAMA VILLAGE MOBILE HOME PRK <br /> Location 10780 N HWY 99 <br /> STOCKTON, CA 95212 <br /> Phone 562-866-4004 <br /> Mailing Address PO BOX 1687 <br /> BELLFLOWER, CA 907071687 <br /> Care of PARK PLACE SERVICES <br /> Location Code 99 - UNINCORPORATED A Alt PhoneA . 7 <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 08607005 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION + <br /> Contact Name J"" <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0001134 <br /> New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner I Facility 1 Account <br /> Account Name TAHAMA VILLAGE MOBILE HOME PRK (Circle one) <br /> Account Balance as of 8!312011: $122.00 <br /> (Circle One) <br /> Transferto Acttvellnactve <br /> ProgramlElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 3611 -PUBLIC POOL/SPA-PRIMARY PR0360467 EE0001084-STEPHANIE RAMIREZ Active Y N A I D <br /> 4242-WASTE WATER TX PLANT PR0420088 , EE0005944-MICHAEL ESCOTTO Active Y N A I D <br /> 1 4622-25-99 SERVICE CONNECTIONS(CWS) WA0460602 EE0005838-ADRIENNE ELLSAESSEActive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,.PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the parry identified as the OWNER on 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 Laws. <br /> APPLICANT'S SIGNATURE: Date 1 / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 I <br /> Payment Type Check Number Receiv <br /> REHS: Dale 1 1 Account out: Date 1 1 <br /> COMMENTS: <br /> i <br /> 11eh-envlenvisionlreports15021.rpt <br />