Laserfiche WebLink
_ Report#5021 <br /> Datebru <br /> nn 4/11120b2 12:45:41PI SAN JOAF -COUNTY ENVIRONMENTAL HEALT' EPARTMENT Paget <br /> Run y �� Facility Information as of 4/11/200Y/ <br /> Record Selection Criteria: Facility ID FA0010042 <br /> Make changes/collections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008042 Case Number: H06316 New Owner ID : —lolls <br /> Owner Name OLIVER&W INSTON <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 818-972-1200 <br /> Mailing Address Q0Q->p{-A' 4' SDA,4,VE L <br /> BURBANK, eA-915Ot3-- dna nc� R gc�0r • I' s <br /> Care of <br /> FACILITY FILE INFORMATION <br /> FacilityID FA0010042 <br /> Facility Name W INSTON TIRE CO#120 <br /> Location 923 S CHEROKEE LN <br /> LODI, CA 95240 20 <br /> Phone 209-369-1025 AA// <br /> Mailing Address ��r�G Ky W>L ♦ n�' <br /> J4\/l..}.iP.4 Q � e}C SEL • I�.i�S <br /> Care of CHRIS BROSSMAN <br /> Location Code 02-LODI APN:047-390-06 <br /> BOS District 004-SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017042 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name WINSTON TIRE CO#120 (Circle One) <br /> Account Balance as of 4/11/2002: $0.00 <br /> TMfer to (Circle One) <br /> ra <br /> Activannaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Ovmer? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO514141 EE0003580-MICHELLE STERNI-LE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512330 EE0000000-HAZ MAT SJC IDES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0510042 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator a agent of same,acknorMedge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> faciity 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 /> Stale and/or Federal Laws. <br /> APPLICANT'S 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 Receiypd by <br /> REHS: Date / / Account out: Date / LL/ 01- <br /> COMMENTS: <br /> \\Phs-ehsgl-nt\apps\Envisions\Reporfs\5021.rpt <br />