Laserfiche WebLink
Date run 3/27/2009 1:52:10PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Pagel <br /> Run by Facility Information as of 3/27/2009 <br /> Record Seleclion Criteria: Facility ID FA0009247 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007247 Case Number: H02373 New OWnef lD <br /> Owner Name FORSLIND, RICHARD E <br /> Owner DBA B&H TRANSMISSIONS INC <br /> Owner Address 7681 AMALGAM ST <br /> ELDORADO, CA 956524847 <br /> Home Phone Not Specified <br /> Work/Business Phone 530-620-7348 <br /> Mailing Address 3422E MINER AVE <br /> STOCKTON, CA 952054790 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009247 <br /> Facility Name B&H TRANSMISSIONS INC <br /> Location 3422 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-464-1317 <br /> Mailing Address 3422 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 143-390-09 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016247 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name B&H TRANSMISSIONS INC (Circle One) <br /> Account Balance as of 3/27/2009: $413.00 <br /> (Circe One) <br /> Transfer to Active/Inacrve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0513723 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511535 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO521188 EEo000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0509247 EE0000000-HAZ MAT SJC DES Inactive 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 spec.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 Ordmace Codes and/or Standards and <br /> State andror Federal Laws. <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 Receiv�edQby <br /> REHS: Dale L_! / 10q Account out: Date 3 <br /> COMMENTS: <br /> \\eh�nv\envision\reports\5021.rpt <br />