BILLING - Laserfiche WebLink

Home Browse Search

-__.._, r :sem?:iii �_.. __-..,..:5'J:,r: ..i ..... ........ .... r ii:_::__r__ __:..�.__._: _: �_.'..;r:C � ?_:_.}_:-•_.___.: r:,'-'c::�s;.:•.::.:r � tr.. __.�S::.vl:t3i:_iw.}. Date run 8/8/2014 9:24:44AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 Run by Pagel Facility Information as of 8/8/2014 Record Selection Criteria: Facility ID FA0017295 OWNER FILE INFORMATION Number of facilities for this owner Owner ID OW0014136 Owner Name ALMEIDA ENTERPRISES Owner DBA ALMEIDA ENTERPRISES Owner Address 30092 E ORANGE AVE 30092 E ORANGE AVE ESCALON, CA 95320 Home Phone Not Specified Work/Business Phone Not Specified Mailing Address 30092 E ORANGE AVE ESCALON, CA 95320 Care of FACILITY FILE INFORMATION Facility ID / CERS ID FA0017295 10186231 Facility Name ALMEIDA ENTERPRISES Location 30092 E ORANGE AVE ESCALON, CA 95320 Phone 209-838-8867 x0 Mailing Address 30092 E ORANGE AVE ESCALON, CA 95320 Care of Location Code BOS District APN 24915015 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0030177 Mail Invoices to Owner Account Name ALMEIDA ENTERPRISES Account Balance as of 8/8/2014—$4 .00 Make changestcorrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) 1 SSN / Fed Tax ID New Owner ID : Alt Phone Fax _ EMail : Mail Invoices to: New Account ID: : Owner / Facility / Account (Circle One) (Circle One) Transfer to Active/Inactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1958 - HM -Farm Operations PR0525480 Active Y N A if D 2220 - SM HW GEN <5 TONS/YR PR0529941 EE0009001 - ELENA MANZO Active Y N A yJ, ` D 2830 - AST FAC - SPCC EXEMPT PR0529940 EE0009001 - ELENA MANZO Active,l Y N A L- D ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0532255 Inactive Y N A I D 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 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 State and/or Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: * $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Receives[Ily' RENS: khOl Date/ << / t Account out: �-� Date COMMENTS: C 1�%( � c -aed oL.- V"' *� 1't L t fa -5- 6�;)