Laserfiche WebLink
Date run 4/15/2016 9:29:24AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 4/15/2016 <br />Record Selection Criteria: Facility ID FA0010860 <br />OWNER FILE INFORMATION Number of facilities for this owner : 17 <br />Owner ID OW0008853 Case Number: H08879 <br />Owner Name <br />SAN JOAQUIN COUNTY <br />Owner DBA <br />PUBLIC WORKS <br />OwnerAddress <br />1810 E HAZELTON AVE <br />STOCKTON, CA 95205 <br />Home Phone <br />209-468-3057 <br />Work/Business Phone <br />209-468-3090 <br />Mailing Address <br />1702 E SCOTTS AVE <br />STOCKTON, CA 95205 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0010860 10183883 <br />Facility Name SJC PUBLIC WORKS /UTILITY-MTCA IND <br />Location 11235 E HWY 120 <br />MANTECA, CA 95336 <br />Phone 209-468-3090 <br />Mailing Address 1702 E SCOTTS AVE <br />STOCKTON, CA 95205 <br />Care of WILLIAM G ARBOGAST <br />Location Code 99 - UNINCORPORATED A <br />BOS District 005 - ELLIOTT, BOB <br />APN 20819019 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <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 />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0017860 New Account ID: <br />Mail Invoices to Account Mail Invoices to: Owner / <br />Account Name SJC PWD UTILITIES MAINTENANCE DISTS <br />Account Balance as of 4/15/2016: $0.00 <br />Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1926 - HMBP-Unstaffed Network Location PR0513148 EE0000009 - NICHOLAS LOEHRER Active Y N A D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0510860 EE0000000 - HAZ MAT SJC OES Inactive Y N A P D <br />2840 -AST EXEMPT FAC < 1,320 GAL PR0529088 EE0000753 - WILLY NG Inactive Y N 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 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 Slate and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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 / / Account out: Date `i / `t/ It, <br />COMMENTS: <br />Invoice #: <br />CIS � c Gn Sn k i r''ePdkbL <br />