Laserfiche WebLink
Date run 7/14/2009 3:53:06PK SAN JOAAUIN COUNTY ENVIRONMENTAL HEAL T i DEPARTMENT Report x5021 <br /> Run by Pagel <br /> Facility Information as of 7/14/201,.. <br /> Record Selection Criteria: Facility ID FA0015883 <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 I OW0012804 New Owner lD <br /> Owner Name GEORGE GARCIA <br /> Owner DBA AD FORCE PRIVATE SECURITY <br /> Owner Address 1625 N REPORT AVE <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-462-8420 <br /> Mailing Address PO BOX 55331 <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015883 <br /> Facility Name AD FORCE PRIVATE SECURITY <br /> Location 1625 N REPORT AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-462-8420 x0 <br /> Mailing Address PO BOX 55331 <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 14316037 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GEORGE GARCIA <br /> Title <br /> Day Phone 209-462-8428 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027639 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AD FORCE PRIVATE SECURITY (Circle One) <br /> Account Balance as of 7/14/2009: $0.00 <br /> (Circle One) <br /> Transfer to Active/Ince <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 2220-SM HW GEN<5 TONSNR PR0527857 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO523504 Active Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PRO529451 EE0009488-JEFFREY WONG Active Y N A If D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersignetl 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 minify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards ai,d <br /> State anrllor Federal Laws. "Y to <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 NumberRecei / <br /> RENS: :4. 1 �.,(6 Date' �4- (-(l nQ Account out: Date l AO / <br /> COMMENTS: <br /> .7 3, <br /> \\eh-env\envision\reports\5021.rpt <br />