Laserfiche WebLink
Date mn 11/24/2015 3:26:38P SANJOA COUNTY ENVIRONMENTAL HEAL EPARTMENT <br /> Report 95021 <br /> Run by - Pagel <br /> Facility Information as of 11/24/2015 <br /> Record Selection Criteria: Facility ID FA0010503 <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/Fed Tax ID : <br /> Owner ID OW0008503 New Owner ID <br /> Owner Name Rod Baker <br /> Owner DBA B&Z AUTO COLOR INC <br /> Owner Address 1507 NINTH ST <br /> MODESTO, CA 953540717 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-652-3389 <br /> Mailing Address 3200 N WEST LN <br /> STOCKTON, CA 95204 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010503 10183605 <br /> Facility Name B&Z AUTO COLOR INC <br /> Location 3200 WEST LN <br /> STOCKTON, CA 95204 <br /> Phone 209-523-1099 x <br /> Mailing Address 1507 9TH ST <br /> MODESTO, CA 95354-0717 <br /> Care of Rod Baker <br /> Location Code Alt Phone <br /> BOS District 002-MILLER, KATHERINE Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017503 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Rod Baker (Circle One) <br /> Account Balance as of 11/24/2015: $0.00 <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-Regular-Primary Location PRO521159 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514365 EE0000005-FATINAH ZAREEF Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512791 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PRO514794 EE0o00000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510503 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531292 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,prism project speck,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this forml also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: Date_/ I Account out: Date / I <br /> COMMENTS: Invoice#: <br />