Laserfiche WebLink
--'- <br /> Ren BIOats y 2/20/2013 11:22:30AI SAN JOti,�JIN COUNTY ENVIRONMENTAL HEA1 DEPARTMENT Report#5021 <br /> Pagel <br /> Facility Information as of 2/20/2013 <br /> Recorb Selecllon Criteria: Facility ID FA0015495 <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 ID OW0012448 New Owner ID <br /> Owner Name SCOTT DEBROUWER <br /> Owner DBA STOUT ROOFING OF CALIFORNIA IN <br /> "Owner Address 3480 CARPENTER RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/BusinessPhone 209-461-7160 <br /> Mailing Address 3480 CARPENTER RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015495 <br /> Facility Name STOUT ROOFING OF CALIFORNIA INC <br /> Location 3480 CARPENTER RD <br /> STOCKTON, CA 95215 <br /> Phone 209-461-7160 xO <br /> Mailing Address 3480 CARPENTER RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 17916040 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026737 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name SCOTTDEBROUWER (Circle One) <br /> Account Balance as of 2/20/2013: $350.00 <br /> (Circle One) <br /> Transfer to Aclivellnaclve <br /> Progrern/Elemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO522724 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PRO532918 Inactive 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 speck.PHS/EHD hourly charges associated with this facility <br /> or activiy,will be billed to the Parry Identified as the OWNER on this torte. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes shNor Standards and State anc(or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: / Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type - Check Number Received by <br /> RENS: Date / / Account out: Date <br /> COMMENTS: - <br />