Laserfiche WebLink
Date run 6/17/2014 4:43:52PR SAN J011sssQIN COUNTY ENVIRONMENTAL HEALsso DEPARTMENT Report N5021 <br /> Ran by <br /> r <br /> Facility Information as of 6/17/2014 Pagel <br /> Record Selection Criteria: Facility ID FA0014330 <br /> Make cha INFORMATION <br /> N H RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) [ / <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner lD OW0015288 New,7ner lD <br /> Owner Name �gpggRE-LANDSCAPINBINC Ile Ufa 67 1 1/►tuHQ�/P ati1 en t <br /> Owner DBAO��NDSCAPLNG-Hd6 t, t <br /> Owner Address 35200 S CHRISMAN RD <br /> TRACY, CA 95377 <br /> Home Phone X42-075t. 5'-'5-q1 _ _ 6 j <br /> Work/Business Phone 209-835-2465 <br /> Mailing Address_-Pg-Beo gc P0, UX 7 <br /> C tot,✓r_ht l_lyf 3&10 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0014330 10184605 <br /> Facility Name c Ctvtag'e ✓n en -}— <br /> Location 35200 S CHRISMAN RD <br /> TRACY, CA 95377 <br /> Phone X94,%. — <br /> Mailing Address <br /> ChauiC- L l[u / G 3 i <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> SOS District 005 - ELLIOTT, BOB Fax <br /> APN 25327019 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024353 NewAccount ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name SYCAMORE LANDSCAPING INC (Circle One) <br /> Account Balance as of 6/17/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/lnacive <br /> Program/Element and Description Record ID Employee ID and Name status New Owri Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520811 EE0002474-MICHAEL PARISSI Inactive @YN A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO519161 EE0000000-HAZ MAT SJC OES Inactive Y N I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO536503 EE0007379-AMANDA BOERTIEN Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532287 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSfEHD hourly charges assodated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also cartiy that all operations will be performed in accordance with all applicable Ordinance Cotles arl Standards and State arl <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 Typ Check Number �LLrr Racal d <br /> RENS: /,C trc ( Date / /J_ Account out: Data <br /> COMMENTS: <br /> Zzy� <br /> Z- : ItNv <br />