Laserfiche WebLink
Date run 6/22/2011 8:53:11AN SAN Jf- IUIN COUNTY EN`'IRONMENTAL HES- —H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/22/2, , <br /> Record Selection Criteria: Facility ID FA0010207 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> SSN/Fed Tax ID <br /> Owner ID OW0008207 Case Number: H07314 New Owner ID <br /> Owner Name SIDNEY CARPER <br /> Owner DBA CARPER'S HAY SERVICE <br /> Owner Address 1229 WOODMAN WAY <br /> MODESTO, CA 95350 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-838-2107 <br /> Mailing Address 1229 WOODMAN AVE <br /> MODESTO, CA 95350 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010207 <br /> Facility Name CARPERS HAY SERVICE <br /> Location 17641 FRENCH CAMP RD <br /> RIPON, CA 95366 <br /> Phone 209-838-2107 <br /> Mailing Address 2027 GRAND CANAL BLVD STE 35 <br /> STOCKTON, CA 95207 1 <br /> Care of C/O RICHARD GIBSON - LAWYER <br /> Location Code Alt Phone <br /> BOS District 005 - ORNELLAS, LEROY Fax <br /> APN 20322021 EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017207 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CARPERS HAY SERVICE (Circle One) <br /> Account Balance as of 6/22/2011: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2221 -USED OIL ONLY-<5 TONS/YR PR0514229 EE0002670-MUNIAPPA NAIDU Active Y N A 61 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512495 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO520144 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR43R0510207 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATRPR0516437 EE0002670-MUNIAPPA NAIDU Active,Exempt Y N A C1� D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0533980 Active Y N A I D <br /> 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 <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 /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Receive <br /> REHS: fM Date Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />