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Report #: 0002 <br /> Date run : 1/12/01 1:43:18PM '4h,.,4AQUIN COUNTY PUBLIC HEALT' �El, . ES Page #: t <br /> Run by TBRIGGS Facility Information as of 1/120W <br /> Record Selection Criteria: FacilityID FA0009522 <br /> P.—el ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> owner ID: OW0007522 Case Number: H04721 New Owner ID <br /> Owner Name: THE MARTIN-BROWER CORP <br /> Owner DBA; <br /> owner Address: <br /> Home Phone: Not Specified <br /> Work/BussnessPhone: 630-271-8300 <br /> Mailing Address: 333 E BUTTERFIELD RD#500 <br /> Care of: <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0009522 <br /> Facility Name: MARTIN-BROWERCO THE <br /> Location: 900 N SHAW RD <br /> STOCKTON, CA 95215 20 <br /> Phone: 209-460-3393 <br /> Mailing Address: 900 N SHAW RD <br /> STOCKTON, CA 95215- <br /> Care of: ,JEFF STEINER <br /> Location Code: 99- UNINCORPORATED AREA APN; 14327061 <br /> BOS District: 002 - MARENCO, DARIO SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0016522 New Account ID:: <br /> Mail Invoices to: Account Mail Invoices to: Owner/ Facility/Account <br /> Account Name: MARTIN-BROWER CO THE (Circle One) <br /> Account Balance as of 1/12/01: $0.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2226-CaIARP PROGRAM PRO514608 EE0000000-SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FE PR0509522 EE0000000-SJC OES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511810 EE0000000-SJC DES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513882 EE0000008-BRIGGS Active Y N A I D <br /> ,,93,90 4borcg*rou�kt� <br /> BILLING and COMP ANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agentof same,acknowledge that all site,and/or <br /> project specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this <br /> form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal <br /> Laws. <br /> APPLICANTS SIGNATURE: Dale / I <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Dale <br /> Payment Type Check Number Receipt Number Received by <br /> RENS: Date / I Account out: Date <br /> 1.0.0.89.00 <br />