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Date rur. 7/2/2002 1:51:19PM SAN J <br />Run -,y <br />0 <br />I Record Selection Criteria: Facility ID FA0007491 <br />OWNER FILE INFORMATION <br />IN COUNTY ENVIRONMENTAL HE. <br />Facility Information as of 7/2/2002 <br />Owner ID OW0006188 <br />Owner Name fb4NU <br />Owner DBA 64 -T C <br />Owner Address $676 vimNcPARD <br />CA 952 12 <br />Home Phone 2$9_931---43g�_ <br />Work/Business Phone 299..933-1789 <br />Mailing Address M76 6-A&4EPA-RD <br />&T - 12 <br />Care of MARK A& PAI II ETTE D A UiO <br />FACILITY FILE INFORMATION <br />Facility ID FA0007491 <br />Facility Name 111 TR4,E-XP4RE-8S-T-RUGX-WA&H <br />Location 1524 FRESNO AVE <br />STOCKTON, CA 95206 <br />Phone 2g��7 <br />Mailing Address 1789 W CHARTER WAY <br />STOCKTON, CA 95206 <br />Care of <br />Location Code 01 - STOCKTON <br />BOS District 001 - GUTIERREZ, STEVE <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />U <br />DEPARTMENT Report #5021 <br />Pagel <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) -7 <br />OWNERSHIP CHANGE (date) 'r� ? (per <br />New Owner ID : 0 (11 ( 0 l 9 1 <br />'; C,) k_�\ h `►1\44, S. C-2 i t � <br />C& MAr V,,e, (Acw !UL' 11:S�n <br />SAr�}rJ�iAr C+� -'ISD 70 <br />GDun IGe,1°rte-, TrL.,r-LVj*s <br />Zoe, 33 — 1-7q ' <br />AA <br />APN: <br />SIC Code: <br />Account ID AR0011647 <br />New Account ID: <br />Mail Invoices to Facility <br />Mail Invoices to: Owner ! <br />Facilit� / <br />Account <br />Account Name <br />wove) <br />Account Balance as of 7/2/2002: $0.00 <br />(Circle One) <br />Transfer to <br />Active/Inactve <br />Program/Element and Description Record ID <br />Employee ID and Name Status <br />New Owner? <br />Delete <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0513176 <br />EE0000000 - HAZ MAT SJC OES Active <br />N <br />A I D <br />2301 - UST STATE SURCHARGE PR0516168 <br />EE0000418 - MICHAEL KITH Inactive <br />N <br />A I D <br />2361 - NEW MULTI UST FACILITY PR0506545 <br />EE0000418 - MICHAEL KITH Active <br />%G N <br />A I D <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE FPR0507670 <br />EE0000418 - MICHAEL KITH Active <br />v N <br />A I D <br />aa�n <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD <br />hourly charges <br />associated with this <br />facility 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 Ordinace Codes and/or Standards and <br />State and/or Federal Laws. <br />A <br />APPLICANT'S SIGNATURE: <br />vD <br />Date / <br />Program Records to be TRANSFERED: * $20.00 = Amount Paid Date <br />Water System to be TRANSFERED: * $155.00 = Amount Paid Date <br />Payment Type Check Number Receiv y <br />REHS: , ; ,,n V 1 f Date _7 / Z l U 'Z Account out: Date 3 / C Z <br />COMMENTS: <br />\\Phs-ehsq I-nt\apps\Envisi ons\Reports\5021. rpt <br />