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owe run 1/22/2007 9:08:35AM SAN JOIN COUNTY ENVIRONMENTAL HEAJ& DEPARTMENT <br /> Run by 5290 Report iR5021 <br /> Facility Information as of 1/22/2007 Pagel <br /> Record selection criteria: Facility ID FA0010925 <br /> Make changes/corrections in RED ink or pencll. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0008925 Case Number: H08982 New Owner ID : <br /> Owner Name OUTDOOR SYSTEMS ADVERTISING IN S pn <br /> Owner DBA VIACOM OUTDOOR <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 2050 W FREMONT ST <br /> STOCKTON, CA 95203 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010925 <br /> Facility Name VIACOM OUTDOOR <br /> Location 2050 W FREMONT ST <br /> STOCKTON, CA 95203 <br /> Phone 209-466-5022 <br /> Mailing Address 2050 W FREMONT ST <br /> STOCKTON, CA 95203 <br /> Care of <br /> Location Code 01 - STOCKTON APN:13336031 <br /> BOS District 001 - GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017925 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name VIACOM OUTDOOR (Circle One) <br /> Account Balance as of 1/22/2007: $0.00 <br /> Program/Element and Description Transfer to (Circle One) <br /> AcuveMactve <br /> Record lD Employee lD and Nave status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO514454 EE0009155-TOUA YANG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIONPRO513213 EE0000000-HAZ MAT SJC OES Inactive Y N A 1 D <br /> 2244-PACT TRANSFER RECORD-OES PR0520553 EE000o000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARCPRO510925 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,atlmovdedge the[all site.and/or proiect specific.PHS/EHO houdy Mages associated with this <br /> reality,or activity will be billed to the party identified as the OWNER on this tons. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> Slate and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$20.00= Amount Paid <br /> Water System to be TRANSFERED: •$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date_/ / Account out: 4 6Date_L/�- 7 <br /> COMMENTS' //m/��yA' Dat <br /> I �" (�/,Gly'_• /lv / V k v--- <br /> \\phsehsgl-nt\apps\envisions\reports\5021.rpt <br />