Laserfiche WebLink
Date run 1/10/200;Facility <br /> 0:19:12AI SAN J( )UIN COUNTY ENVIRONMENTAL HEA 'H DEPARTMENT <br /> Report 85021 <br /> Run by �..a Pagel <br /> Facility Information as of 1/10/208 <br /> Record Selection Cntena: ID FA0006977 <br /> Make changesicorrections in RED ink or perIcil. <br /> INFORMATION CHANGE(date) (QD O`3 <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0014838 New Owner ID <br /> Owner Name KOMAL BROS INC <br /> Owner DBA <br /> Owner Address 1517 WATERSTONE PL <br /> SAN RAMON, CA 94582 <br /> Home Phone 209-983-4781 <br /> Work/Business Phone 213-448-5651 <br /> Mailing Address 5777 S FRENCH CAMP RD <br /> STOCKTON, CA 95206 <br /> Care of KOMAL BROS INC <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006977 <br /> Facility Name 76 EXPRESS TIGER NO 1 <br /> Location 5777 S FRENCH CAMP RD <br /> STOCKTON, CA 95206 <br /> Phone 209-983-4781 <br /> Mailing Address 5777 S FRENCH CAMP RD <br /> STOCKTON, CA 95206 <br /> Care of KOMAL BROS INC <br /> Location Code 01 -STOCKTON APN:19302037 <br /> BOIS District 001 - GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0009954 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name 76 EXPRESS TIGER NO 1 Circle One) <br /> Account Balance as of 1/10/2008: $210.00 <br /> (Circle One) <br /> Transfer to ActivellnacNe <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Ownef! Delete <br /> 1617-RETAIL MARKET>1000 SO FT W/FOOD FPRO506134 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> 4-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO513520 EE0000000-HAZ MAT SJC OES Inactive Y N A D <br /> 222 GEN 5<25 TONS PERMIT PR0518770 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO520766 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PRO515565 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2361 -UST FACILITY PRO505746 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO507643 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO526054 EE0000060-JENNIFER FRASE Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned!ovmer,operator or agent of same,ackno edge Mat all site,and/or project specific,PHS/EHO hourly charges associated with this <br /> facky 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 Ordirace Codes and/or Standards ant <br /> State a"or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date / / <br /> Payment Type Check Number Receiv <br /> REHS: e- [von, ) `Iic� Date _/I/O /�/� Account out: �7 _\ Date / / B <br /> COMMENTS:DRa— Glr`A^� PE ZL 1u <br /> fa L, I i J— 00,1 <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />