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yrjate run a 3/9/2022 4:20:02PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 3/9/2022 <br />Record Selection Criteria: Facility ID FA0022270 <br />Make changestcorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION <br />Number of facilities for this owner: 1 SSN / Fed Tax ID <br />Owner ID <br />OW0018554 <br />New Owner ID <br />Owner Name <br />NORTHWEST CASCADE INC <br />Owner DBA <br />OwnerAddress <br />1512 S VILTON RD <br />PITTSBURG, CA 94565 <br />Work/Business Phone <br />800-325-2371 <br />Alternative Phone <br />415-683-9443 <br />Mailing Address <br />PO BOX 73399 <br />PUYALLUP, WA 98373 <br />Care of <br />Te�►Pesx A <br />FACILITY FILE INFORMATION APN <br />Facility ID / CERS ID <br />FA0022270 <br />Facility Name <br />HONEY BUCKET <br />Location <br />104 AVILA RD <br />PITTSBURG, CA 94565 <br />Phone <br />800-325-2371 <br />Mailing Address <br />PO BOX 73399 <br />PUYALLUP, WA 98373 <br />Care of <br />eResa- Uzi Y`e <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />NIC BOSCH <br />Title <br />4156839443 <br />Day ~hone <br />415-683-9443 <br />Night Phone <br />800-325-2371 <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID <br />AR0040653 <br />New Account ID: <br />Mail Invoices to <br />Facility <br />Mail Invoices to: Owner / Facility / Account <br />Account Name <br />HONEY CKET <br />(Circle One) <br />Email invoice to (up to 2 emails) <br />tax scade.com; teresachavez@nwcas � X &wcasc� x om <br />Email permit to (up to 2 emails) <br />taX ascade.com; teresachavez@nwcas io c @ N W CGWC . C0" <br />Account Balance as of 3/9/2022: <br />$0.00 <br />(Circle One) <br />Program/Element and Description <br />Record ID <br />Transfer to Active/Inactve <br />Employee ID and Name Status New Owner? Delete <br />4244 - PUMPER TRUCK <br />PR0538786 <br />EE0009488 - JEFFREY WONG Active Y N A I D <br />4244 - PUMPER TRUCK <br />PR0538787 <br />EE0009488 - JEFFREY WONG Active Y N A I D <br />4244 - PUMPER TRUCK <br />PR0538788 <br />EE0009488 - JEFFREY WONG Active Y N A I D <br />4255 - CHEMICAL TOILETS <br />PR0538789 <br />EE0009488 - JEFFREY WONG Active Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: <br />I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or 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 and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: ` $25.00 = <br />Amount Paid Date <br />Water System to be TRANSFERED: <br />Amount Paid Date <br />Payment Type <br />Check Number <br />Received by <br />EHD Staff: <br />Date / <br />/ Account out: Date 2 - <br />COMMENTS: COMMENTS: <br />Invoice #: <br />