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Date run 12/8/2017 4A2:36PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility information as of 12/8/2017 <br /> Record Selection Criteria: Facility ID FAOD05893 <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 I Fed Tax ID <br /> Owner ID OW0015084 New Owner ID <br /> Owner Name WEST COASTARBORISTS <br /> Owner DBA WEST COASTARBORISTS INC <br /> OwnerAddress 436 W SCOTTS AVE <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/Business Phone 714-991-1900 <br /> Mailing Address 436 W SCOTTS ST <br /> STOCKTON, CA 95203 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID!CERS ID FA0005893 10181977 <br /> Facility Name WEST COASTARBORISTS INC <br /> Location 436 W SCOTTS AVE <br /> STOCKTON, CA 95203 <br /> Phone 209-547-0297 x0 <br /> Mailing Address 436 W SCOTTS ST <br /> STOCKTON, CA 95203 <br /> Care of West Coast Arborists <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 14704053 EMaii <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Kenji Ota <br /> Title Shop Foreman <br /> Day Phone 209-547-0297 <br /> Night Phone 209-810-5015 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0006771 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner ! Facility ! Account <br /> Account Name WEST COASTARBORISTS INC (circle One) <br /> Account Balance as of 12/8/2017.- $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO525752 EE0009817-ROBERT LOPEZ Inactive Y N f _ D <br /> 2221 -USED OIL ONLY-<5 TONSIYR PRO538465 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1184)-obsolete PR0503599 EECDO0008-LETITIA BRIGGS Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO524164 EE0007379-AMANDA BOERTIEN Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO534368 InaCtivi Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. ],the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSJEHD 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 and/or Standards and State andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I f <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> EHD Staff: Date 1 1 Account out: Date 1 1 <br /> COMMENTS: <br /> Invoice#: <br />