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BILLING
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4 (STATE ROUTE 4)
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14125
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1900 - Hazardous Materials Program
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PR0538329
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BILLING
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Entry Properties
Last modified
11/20/2024 9:09:06 AM
Creation date
6/9/2018 8:42:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
BILLING
RECORD_ID
PR0538329
STREET_NUMBER
14125
STREET_NAME
STATE ROUTE 4
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\F\HWY 4\14125\PR0538329\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
8/18/2015 8:35:50 PM
QuestysRecordID
2835378
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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.Datemn s 2/10/2015 2:11:58PK SAN JOAN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Report#5021 <br /> Run by Pagol <br /> Facility Information as of 2I10I2015 <br /> Record Selection Criteria: Facility ID FA0016941 <br /> Make changes/corrections in 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 ID OW0013782 New Owner ID <br /> Owner Name ENSHER ALEXANDER BARSOOM INC <br /> Owner DBA ENSHER ALEXANDER BARSOOM INC <br /> Owner Address 0 UPPER JONES TRACT(CAMP 2 <br /> HOLT, CA 95234 <br /> Home Phone Not Specified <br /> WorklBusiness Phone Not Specified <br /> Mailing Address PO BOX 27 <br /> HOLT, CA 95234 <br /> Care of <br /> FACILITY FILE INFORMATION 1 OQ(a tto3 <br /> Facility ID/CERS ID FA0016941 -4et8'5657 <br /> Facility Name ENSHER ALEXANDER BARSOOM INC <br /> Location 0 UPPER JONES TRACT(CAMP 2 <br /> HOLT, CA 95234 <br /> Phone 916-417-5269 xO <br /> Mailing Address PO BOX 27 <br /> HOLT, CA 95234 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 12920012 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 AR0029823 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name ENSHER ALEXANDER B RRSOOM INC (Circle One) <br /> Account Balance as of 2/10/2015: $107.00 W <br /> �� �m O,9Op1,1 (circle One) <br /> P g11 /�R O f�' D Transferto Active/Inacive <br /> M.fement antl Descr huh - r+ Record ID Employee ID and Name Status New Owner! Delete <br /> 1958-HM-Farm Operations PROS25126 Active Y N A I D <br /> 2221 -USED OIL ONLY-<5 TONSNR PR0538591 Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532807 Inactivt 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,PHSIEHO hourly charges associated with this facility <br /> or activity will be billed to the parry identified as the OWNER on this form. Ialso certify that all operations wdl ba Performed in accordance with all applicable Ordinance Codesand'or Standardsand Stetemdw <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 Recelvd y <br /> RENS: tA4 Date 2 / tt / t Account out: Date <br /> COMMENTS: <br /> a°°4 <br />
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