Laserfiche WebLink
Date rim, 10/14/2020 2:17:01P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by M OZUNA Pagel <br /> Facility Information as of 10/14/2020 <br /> Record Selection Criteria: Facility ID FA0017710 <br /> Make changes/corrections 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 OW0014535 New wrier ID <br /> Owner Name Or, l-'tyr 13 o r", ►rcW2�- 4� L L <br /> Owner DBA N a-}im"L� S C V,` C- I,lt1+M <br /> Owner Address 1 r <br /> seySJE 4-2 <br /> Work/Business Phone Not Specified $O ,— <br /> Alternative Phone �J L(- <br /> Mailing Address ILLOW PASS RD Qa'—6 gQ — �'f' 3 Sal Y� �j o� <br /> Care of <br /> FACILITY FILE INFORMATION APN 24130052 <br /> Facility ID/CERS ID FA0017710 <br /> Facility Name A AS rJ <br /> Location 401 S AIRPORT WAY <br /> MANTECA, CA 95336 <br /> Phone 209-99,.4JM0 <br /> Mailing Address 4 P Y �i U 5u WIt !0(3 <br /> MAb CA, CA-9"�3� r A-- 4 RILL <br /> Care of <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Rob,P_r-� � p� <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030879 NewAccount ID: <br /> Mail Invoices to Facility 1L Mail Invoices to: Owner / Facility / Account <br /> Account Name a Circle One) <br /> Ls <br /> Email invoice to(up to 2 emails) �r✓jG2S <br /> Email permit to(up to 2 emails) <br /> Account Balance as of 10/14/2020: $613.00 <br /> (Circle One) <br /> Program/Element and Description Transfer to Active/Inactve <br /> Record ID Employee ID and Name Status <br /> New Owner? Delete <br /> 4242-WASTE WATER TX PLANT PR0526172 EE0000034-NASEEM AHMED Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ancYor 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 andror <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Plea� A,4yi� 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 / Account out: Date _/ 2 / 20 <br /> COMMENTS: <br /> Invoice#: <br />