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Date run Report #5021 <br />Pagel <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />Facility Information as of 4/3/2024 <br />Run by <br />4/3/2024 8:14:11AM <br />Record Selection Criteria: Facility ID FA0002345 <br />1 OWNER FILE INFORMATION Number of facilities for this owner: <br />Owner ID <br />Owner Name <br />Owner DBA <br />Owner Address <br />Work/Business Phone <br />Alternative Phone <br />Mailing Address <br />Care of <br />OW0001806 <br />SHORES HOMES ASSOCIATION, THE <br />SHORES HOME ASSOCIATION <br />3828 N MONITOR CIR <br />STOCKTON, CA 95219 <br />209-943-2090 <br />209-943-2090 <br />3828 N MONITOR CIR <br />STOCKTON, CA 95219 <br />SHORES HOME ASSOCIATION, THE <br />Facility ID / CERS ID <br />Facility Name <br />Location <br />Phone <br />Mailing Address <br />Care of <br />FA0002345 <br />SHORES HOMEOWNERS ASSOCIATION <br />3804 N MONITOR CIR <br />STOCKTON, CA 95219 <br />209-943-2090 <br />4512 FEATHER RIVER DR <br />STOCKTON, CA 95219 <br />THE SHORES -ALLABOUT NUMBERS <br />it -I- <br />3(aaS N. MOOD 12 CA Kele, <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />SHORES HOME ASSOCIATION, <br />209-943-2090 <br />209-943-2090 <br />Uq-5L-i?----} <br />(Circle One) <br />Transfer to Active/lnactve <br />New Owner? Delete Status Record ID Employee ID and Name <br />Active Y NAI D 3611 - PUBLIC POOL/SPA- PRIMARY PR0360448 EE0009818 - LYDIA BAKER <br />Invoice #: <br />Payment Type Check Number <br />EHD Staff: <br />COMMENTS: <br />Make changes/corrections in RED ink. <br /> <br />INFORMATION CHANGE (date) <br /> <br />OWNERSHIP CHANGE (date) <br />FACILITY FILE INFORMATION APN 09826058 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID <br />Mail Invoices to <br />Account Name <br />Email invoice to (up to 2 emails) <br />Email permit to (up to 2 emails) <br />Account Balance as of 4/3/2024: $0.00 <br />Program/Element and Description <br />AR0002359 <br />Facility <br />SHORES HOMEOWNERS ASSOCIATION <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: 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: Date <br />Program Records to be TRANSFERED: * $25.00 = Amount Paid <br />Water System to be TRANSFERED: Amount Paid <br />Date <br />Date <br /> Received <br />/ Account out: <br />b <br />Date <br />SSN / Fed Tax ID : <br />New Owner ID : <br />3.0ct-e5 <br />"7( D -+ <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />Date