Laserfiche WebLink
Date run 2/16/2016 2:35:11Ph 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 FA0003617 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />Owner ID <br />OW0002703 <br />Owner Name <br />BIRCH, WELDON <br />Owner DBA <br />CAL -WEST CONCRETE CUTTING INC <br />Owner Address <br />1153 VANDERBILT CR <br />Phone <br />MANTECA, CA 95337 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />510-656-0253 <br />Mailing Address <br />1 <br />Location Code <br />M <br />Care of <br />RICK CISSELL, MGR <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0003617 10181245 <br />Facility Name <br />CAL WEST CONCRETE CUTTINGS INC <br />Location <br />1153 VANDERBILT CIR <br />Delete <br />MANTECA, CA 95337 <br />Phone <br />209-823-2236 x <br />Mailing Address <br />1t5-3 AA��IR <br />A <br />337 <br />Care of <br />RICK CISSELL, MGR <br />Location Code <br />04 - MANTECA <br />Bos District <br />005 - ELLIOTT, BOB <br />APN <br />22119031 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0003195 <br />Mail Invoices to Account <br />Account Name CAL WEST CONCRETE CUTTINGS INC <br />Account Balance as of 2/16/2016: $548.00 <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 />_079 4G0 <br />�� ►,>�ec ti , C A <br />Site Mitigation Facility <br />ojct� q 6 <br />Mc,C 1 (� (fig <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-Regular-Primary Location <br />PR0520349 <br />EE0000010 - PETER LOMBARDI <br />Active <br />Y N <br />A <br />I D <br />2220 - SM HW GEN <5 TONS/YR <br />PR0513841 <br />EE0009001 - ELENA MANZO <br />Active <br />Y N <br />A <br />I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0511734 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y N <br />A <br />I D <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete <br />PR0231745 <br />EE0007289 - ALISON YOUNGBLOOD <br />Inactive <br />Y N <br />A <br />I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F <br />PR0509446 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y N <br />A <br />I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG <br />PR0533846 <br />Inactive <br />Y N <br />A <br />I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, <br />PHS/EHD 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 <br />will be performed in accordance with all applicable Ordinance Codes and/or 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 //Z/ <br />Invoice it: <br />4 4 l 11'J S 4 C"'f C�f CC -0, <br />fed - <br />Me, 'i <br />