BILLING - Laserfiche WebLink

Home Browse Search

Date run 4/21/2014 10:23:32AI SAN JOA,,IN COUNTY ENVIRONMENTAL HEAL' _ JEPARTMENT Report#5021 Run by Pagel Facility Information as of 4/21/2014 Record Selection Criteria: Facility ID FA0016211 Make changes/corrections in RED ink. INFORMATION CHANGE(date) OWNERSHIP CHANGE(date) OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID Owner ID OW0013107 NeyrOwner ID Owner Name CITY OF STOCKTON Owner DBA STOCKTON POLICE NORTH FACILITY Owner Address 22 E MARKET ST STOCKTON, CA 95202 Home Phone 209-937-8377 Work/Business Phone 209-937-8246 Mailing Address 22 E MARKET ST n i STOCKTON, CA 95202 ��t Care of Uk FACILITY FILE INFORMATION Facility ID/CERS ID FA0016211 10,185,123 I l Facility Name STOCKTON POLICE NORTH FACILITY t-1 rqJ-15e-1 T I/LIVJ Location 7209 TAM O'SHANTER / STOCKTON, CA 952103370 A ` L j Phone 209-937-8248 Mailing Address 22 E MARKET ST m STOCKTON, CA 952022802 Care of V / r Location Code 01 -STOCKTON Alt Phone BOS District 002- RLIHSTALLER, LARRY Fax APN 09403036 EMail: EMERGENCY NOTIFICATION CONTACT INFORMATION / Contact Name u w Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0028334 ,�V' R� NewAccount ID: Mail Invoices to Account 1N J Mail Invoices to: Owner / Facility / Account Account Name STOCKTON POLICE NORTH FACILITY (Circle One) Account Balance as of 4/21/2014: $320.00 (Circle One) Transfer to Active/Inactve Program/Element and Description i Record ID Employee ID and Name Status New Owner? Delete 1921 -HMBP-Regular-Primary Location_ — PR0524120 EE0006044-LOWELL ALLEN Active Y N A '.� , D 2831 -AST FAC >/=1,320-a10 K GAL CUMULATIVE PR0528136 EE0004636-GARRETT BACKUS Active,l Y N A D 4557-MED WASTE LIMITED HAULER PR0536389 EE0003973-ROBERT MCCLELLON InactivE Y N A I D ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532558 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 PaymenCheck Number Received b r REHS: 5; h Date / / Account out: i T, p Date COMMENTS � �� I C� � �r a