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Date run 2/16/2016 2:42:21PK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 2/16/2016 <br />Record Selection Criteria: Facility ID FA0020243 <br />OWNER FILE INFORMATION Number of facilities for this owner: 2 <br />Owner ID <br />OW0009059 Case Number: H09227 <br />Owner Name <br />UNITED FACILITIES INC <br />Owner DBA <br />UNITED FACILITIES <br />Owner Address <br />25451 S MOUNTAIN HOUSE PKWY <br />209-547-8040 x <br />TRACY, CA 953779717 <br />Home Phone <br />209-547-8040 <br />Work/Business Phone <br />309-699-7271 <br />Mailing Address <br />pf)-843-)(-tJfq <br />01 - STOCKTON <br />147 <br />Care of <br />APN <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0020243 10187549 <br />Facility Name <br />UNITED FACILITIES <br />Location <br />4718 NEWCASTLE RD <br />STOCKTON, CA 95215 <br />Phone <br />209-547-8040 x <br />Mailing Address <br />P4ar-BIDXX- 8% <br />.c.s <br />�-7 1 LA e� c <br />M 7 <br />Care of <br />United Facilities <br />Location Code <br />01 - STOCKTON <br />BOS District <br />001 - VILLAPUDUA, CARLOS <br />APN <br />18110014 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0036146 <br />Mail Invoices to Account <br />Account Name UNITED FACILITIES <br />Account Balance as of 2/16/2016: $305.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner ID : <br />.c.s <br />�-7 1 LA e� c <br />Soc-V-k01J C <br />If <br />1 g Ne'JG�s� 1e <br />5 �'g(:--V- 0)'J t C- A�• I - <br />S <br />Alt Phone <br />Fax <br />EMail : <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1921 - HMBP-Reqular-Primary Location PRO535951 EE0000009 - NICHOLAS LOEHRER Active Y N A I D <br />4740 - WASTE TIRE SITE - EXEMPT PRO535003 EE0009000 - HARPRIT MATTU Active Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0536022 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 specific, PHSrEHD 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 andror Standards and State and(or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: <br />COMMENTS <br />* $25.00 = <br />Date <br />Date <br />Amount Paid Date <br />Amount Paid Date <br />Received by <br />Account out: Date <br />Invoice #: <br />C- kcvNge 11N5 A4loi �rED <br />PO Btpk kci is fer <br />vv,- <br />* <br />^ <br />