Laserfiche WebLink
Report k5021 <br /> Date nm 3/26/2014 8:05:44Ak SAN JO*1N COUNTY ENVIRONMENTAL HEALODEPARTMENT Pagel <br /> Run by Facility Information as of 3/26/2014 <br /> Record Selection Criteria: Fetllily ID FA0021428 <br /> Make changestcorrections 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 OW0017621 New Owner ID <br /> Owner Name CTDI <br /> Owner DBA <br /> Owner Address 25201 S SCHULTE RD <br /> TRACY, CA 95377 <br /> Home Phone 909-705-9181 <br /> Work/Business Phone 209-832-6364 <br /> Mailing Address 25201 S SCHULTE RD <br /> TRACY, CA 95377 <br /> Care of CTDI <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021428 10,187,899 <br /> Facility Name CTDI <br /> Location 25201 S SCHULTE RD <br /> TRACY, CA 95377 <br /> Phone 209-832-6364 <br /> Mailing Address 25201 S SCHULTE RD <br /> TRACY, CA 95377 <br /> Care of CTDI Alt Phone <br /> Location Code 03-TRACY <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 20944028 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION New Account ID: <br /> Account ID AR0038793 <br /> Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Owner (Circe one) <br /> Account Name CTD l, aqic, IF.-> r4 <br /> Account Balance as of 3/26/2014: ^��� (Circle One) <br /> Transfer to AclivellnacNe <br /> Record ID Employee ID and Name <br /> Status New Owner' Delete <br /> Prog2MElemenl and DescriptioRecord �, N /{ �1 D <br /> PR0537312 EE0002474-MICHAEL PARISSI Active �,� <br /> 1921 -HMB COMPLIANCE <br /> ACKNOWLaryEDGEMENT <br /> Location PHS'EHD hourly charges associated with this facility <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the <br /> a,tlisform owner,operator or agentti same,a a pewedgerforms that allsite, <br /> ceandfor with <br /> project specific. Y <br /> or activity will be billed to the party itlent�etl as the OWNER on mis form. I also certify that ell operations will be performed in accordance with ell applicable Ordinance Caries andor Standards and State endor <br /> Federal Laws. <br /> Date <br /> APPLICANT'S SIGNATURE: <br /> Amount Paid Date <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date_/_/--- <br /> Water System to be TRANSFERED: Race y <br /> Payment Type Check Number SIL <br /> Date / /.- -- Account out: Date <br /> REHS: ✓t�� 1 �r <br /> COMMENTS'. �^ / .�1^ 1 4 M� 7-si / 1 2-t pe, 3-2—S,("4 �✓sf <br />