Laserfiche WebLink
Date mn 12/1/2004 8:48:28Ah SAN JC HN COUNTY ENVIRONMENTAL HEP 1 DEPARTMENT Report#5021 <br />Run by '% n Pagel <br />Facility Information as of 12/7/2004 <br />Record selection criteria: Facility ID FA0010129 <br />Make changes/corrections in RED ink or pencil. <br />FI INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION <br />Owner ID OW0008129 Case Number: H06748 New Owner ID <br />Owner Name FRED GASSNER <br />Owner DBA MEPCO LABEL SYSTEMS <br />Owner Address <br />Home Phone Not Specified <br />Work/Business Phone 209-772-1666 <br />Mailing Address PO BOX 932 <br />STOCKTON, CA 95201 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID FA0010129 <br />Facility Name MEPCO LABEL SYSTEMS <br />Location 29 N AURORA ST <br />STOCKTON, CA 95202 <br />Phone 209-946-0201 <br />Mailing Address PO BOX 932 <br />STOCKTON, CA 95201 <br />Care of <br />Location Code 01 - STOCKTON APN:149-190-06 07 <br />BOIS District 001 - GUTIERREZ, STEVE SIC Code:9900 <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0017129 New Account ID: <br />Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br />Account Name FRED GASSNER (Circle One) <br />Account Balance as of 12/7/2004: $0.00 <br />(Circle One) <br />Transfer to Active/Inacwe <br />Program/Element and Description Record ID Employee ID and Name Status New Omen Delete <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512417 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />2244 - PACT TRANSFER RECORD - OES PR0520087 EE0000000 - HAZ MAT SJC OES Active Y N A I D <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE FPR0510129 EEOOo0000 - HAZ MAT SJC OES Inactive 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 identiaed as the OWNER on this tone. I also certify that all operations will be performed in accordance with all applicable Ond ince Codes and/or Standards aria <br />State aMlor Federal Laws. <br />APPLICANTS SIGNATURE: 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 Received by <br />RENS: EJ-3 7-7 Date z,/ Date.-L2- 0 / <br />COMMENTS: <br />��-ea.d2 /YZ�i.U��S�a�✓/ Z Z Z 6` � � G���Z;(� ✓ <br />74� <br />\\phschsgl-nt\apps\envisions\reports\5021.rpt <br />