Laserfiche WebLink
—LU, J , <br /> Run by : CARL San Joaquin Codnty •PHS/EHD eport #5021 <br /> FACILITY INFORMATION as of 10/16/915. <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make d ons in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORM ate): <br /> OWNER e): <br /> OWNER ID: 002106 New nwner ID: 00 i <br /> Owner Name: PEARCE, JEFF H _ <br /> Owner DBA: KAISER ROAD TRUST <br /> Owner Address: 708 GLENHILL CT <br /> NOVATO, CA 94947 <br /> Home Phone: 415- 898- 8052 <br /> Work/Business Phone: 209-463-1919 <br /> Mailing Address: 708 GLENHILL CT <br /> care of: PEARCE, JEFF H <br /> NOVATO, CA 94947 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 002805 <br /> Facility Name: PEARCE, JEFF H <br /> Location: 5125 S KAISER RD <br /> STOCKTON 95215 <br /> Phone: 415- 898-8052 <br /> Mailing Address: 708 GLENHILL CT <br /> Care of: PEARCE, JEFF H <br /> NOVATO, CA 94947 <br /> Location Code: 9 9 APN: _ <br /> BOS District: 004 SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0002366 New Account 1D: <br /> Mail Invoices to: Facility Mail Invoices to: C Cility / Account <br /> Account Name: PEARCE, JEFF H ) <br /> Account Balance as of 10/16/95 : $39 . 00 ircle one) <br /> Record UST(s) Tr, vate / Inactivate <br /> P/E Description 1D Employee Status Linked ne Delete <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> d <br /> 2755 EMPLOYEE HOUSING $ O-V 09 PR270040 9157 BARCELLOS ACTIVE A I D <br /> 4630 NTNC WS � o a n WA461354 0370 ACTIVE A I D <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same at all site and/or <br /> project specific PHS/END hourly charges associated with this facility or activity will be bi y identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordan icable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7 - -i- - - ��- - - - - <br /> PR Records to be TRANSFERED: x $20.00 Amount Paid `/ -V <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid <br /> Payment Type Check # F <br /> ------------------------- <br /> REHS or COUNTER SUPV: Date / / ACCT out:_ Date ( / File: / / <br />