Laserfiche WebLink
Date run 4/12/2016 3:28:14Pfv SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 4/12/2016 <br />Record Selection Criteria: Facility ID FA0009801 <br />OWNER FILE INFORMATION Number of facilities for this owner : 1 <br />Owner ID <br />OW0007801 Case Number: H05456 <br />Owner Name <br />WOODLAKE CLEANERS INC. <br />Owner DBA <br />WOODLAKE CLEANERS <br />Owner Address <br />2401 W TURNER RD #220 <br />2401 W TURNER RD #220 <br />LODI, CA 95242 <br />Home Phone <br />209-334-1648 <br />Work/Business Phone <br />209-334-1648 <br />Mailing Address <br />2401 W TURNER RD #220 <br />004 - WINN, CHARLES <br />LODI, CA 95242 <br />Care of <br />MACHADO, DEAN <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0009801 10182919 <br />Facility Name <br />WOODLAKE CLEANERS INC. <br />Location <br />2401 W TURNER RD STE 220 <br />New Owner? <br />Lodi, CA 95242 <br />Phone <br />209-334-1648 x <br />Mailing Address <br />2401 W TURNER RD #220 <br />LODI, CA 95242 <br />Care of <br />DEAN MACHADO <br />Location Code <br />02 - LODI <br />Bos District <br />004 - WINN, CHARLES <br />APN <br />01530006 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name MACHADO, DEAN <br />Title <br />Day Phone 209-334-1648 <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0016801 <br />Mail Invoices to Account <br />Account Name WOODLAKE CLEANERS INC. <br />Account Balance as of 4/12/2016: $0.00 <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 />Site Mitigation Facility <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 <br />Record ID <br />Employee ID and Name <br />Status <br />New Owner? <br />Delete <br />1921 - HMBP-Reqular-Primary Location <br />PR0519878 <br />EE0008709 - JAMIE DE LA ROSA <br />Active <br />Y N <br />A D <br />Q <br />2220 - SM HW GEN <5 TONS/YR <br />PRO514040 <br />EE0001422 - ARIS VELOSO <br />Active <br />Y N <br />A D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PRO512089 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y N <br />A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FE <br />PRO509801 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y N <br />A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI <br />PR0533949 <br />Inactive <br />Y N <br />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, PHS/EHD hourly charges <br />associated <br />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 <br />will be performed in accordance with all applicable Ordinance Codes and/or Standards and <br />State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: ' $25.00 = <br />Water System to be TRANSFERED: <br />Amount Paid _ <br />Amount Paid <br />Date <br />Date <br />Payment Ty e, Check Number Received <br />EHD Staff: �i�- Date / / Account out: Date //�2 <br />COMMENTS: <br />Invoice# <br />t-n�, I I�YJ � ,9_/�,{/J(1wl ,J�✓�JVN 1 w •�J <br />Cil M,tJ", <br />