Laserfiche WebLink
Date run 11/21/2013 9:30:35A SAN JO�N COUNTY ENVIRONMENTAL HEA �IEPARTMENT Report <br /> Run by 7!c Pagel <br /> Facility Information as of 11/2112013 <br /> Record Selection Cuisine: Facility ID FA0004567 <br /> Make changesicorrections In RED ink. <br /> INFORMATION CHANGE(date) J <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner to OW0018049 New Owner ID <br /> Owner Name ORCHARD SUPPLY COMPANY LLC <br /> Owner DBA ORCHARD SUPPLY HARDWARE <br /> Owner Address 1000 LOWES BLVD <br /> MOORESVILLE, NC 28117 <br /> Home Phone 704-758-2751 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1000 LOWES BLVD <br /> MOORESVILLE, NC 28117 <br /> Care of TAX DEPT <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0004567 10,181,661 <br /> Facility Name ORCHARD SUPPLY HARDWARE#490 <br /> Location 360 S CHEROKEE LN <br /> LODI, CA 95240 <br /> Phone 209-368-2600 x0 <br /> Mailing Address 1000 LOWES BLVD <br /> MOORESVILLE, NC 28117 <br /> Care of <br /> Location Code 02 - LODI Alt Phone <br /> BOIS District 004-VOGEL, KEN Fax <br /> APN 04745035 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ORCHARD SUPPLY HARDWARE <br /> Title KATE KOSCHEI <br /> Day Phone 619-677-0150 x3002 <br /> Night Phone 209-368-2500 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004346 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name ORCHARD SUPPLY HARDWARE#490 (arae one) <br /> Account Balance as of 11/21/2013: $0.00 <br /> (Circle One) <br /> Transfer to Active/Ince <br /> PrograMElement and Description Record!ID Employee ID and Name Status New Owner? Delete <br /> 1615-RETAIL MKT 301-2000 SQ FT(PREPKGD/LTD PF PRO500069 EE0001084-STEPHANIE RAMIREZ Inactive Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO520360 EE0008709-JAMIE DE LA ROSA Active Y N A 0 D <br /> 2220-SM HW GEN<5 TONS/YR PR0535764 EE0005642-MICHELLE HENRY Active Y N A 1 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512347 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510059 EEo000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533774 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,aanowledge that all site,anchor 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, l also certify that all operations will be performed in accordance with all applicable Ordinance Codes anchor Standards and State andfor <br /> Federal Laws. <br /> P,,� V �26U3 <br /> APPLICANTS 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 rheck Number , Re e y / <br /> REHS c�A.��2 Date I�/�/ Account out: Date 1�11�1 <br />