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Date run X1112003 11:30:46! SAN JC )UIN COUNTY ENVIRONMENTAL HEA' -'H DEPARTMENT Report#5021 <br /> Run by R `1 Pagel <br /> Facility Information as of 12/11/23 <br /> Record Selection Criteria: Facility lD FA0007968 <br /> Make changesicorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0006586 New Owner ID <br /> Owner Name ARS HEARTWATCH <br /> Owner DBA ARS HEARTWATCH <br /> Owner Address 518 BRECK CT <br /> BENECIA, CA 94510 <br /> Home Phone 925-952-9265 <br /> Work/Business Phone Not Specified <br /> Mailing Address 2770 LARKEY LN tat 02 <br /> WALNUT CREEK, CA 94596 L glp�]g <br /> Care of JACK ALEXANDER <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007968 ' <br /> Facility Name ARS HEARTWATCH W14LP1!7 l <br /> Location 518 BRECK CT <br /> BENECIA, CA 94510 <br /> Phone <br /> Mailing Address 2770 LARKEY LN <br /> WALNUT CREEK, CA 94596 <br /> Care of ,LACK ALEXANDER <br /> Location Code 98-OUT OF COUNTY APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0014787 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner I Facility 1 Account <br /> Account Name ARS HEARTWATCH (Circle One) <br /> Account Balance as of 12/11/2003: $70.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4557-MED WASTE LIMITED HAULER PRO508162 EE0000988-K ASEY FOLEY Active 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 specific,PHSlEHD hourly charges associated with this <br /> facility or attivity 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date ! / <br /> Water System to be TRANSFERED: "$155.00= Amount Paid Date / 1 <br /> Payment Type Check Number Re "ved by <br /> RENS: Date ! / Account out: ate 1 1 P3 <br /> COMMENTS: <br /> k1Phs-ehsgj-ntlappslEnvisiorlslReports15021.rpt <br />