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BILLING_PRE 2019
Environmental Health - Public
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EHD Program Facility Records by Street Name
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INDUSTRIAL PARK
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2200 - Hazardous Waste Program
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PR0540612
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BILLING_PRE 2019
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Entry Properties
Last modified
12/5/2018 11:46:55 AM
Creation date
11/1/2018 8:51:11 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
BILLING_PRE 2019
FileName_PostFix
PRE 2019
RECORD_ID
PR0540612
PE
2221
FACILITY_ID
FA0013569
FACILITY_NAME
SUMMIT ROOFING SERVICES
STREET_NUMBER
705
Direction
E
STREET_NAME
INDUSTRIAL PARK
STREET_TYPE
DR
City
MANTECA
Zip
95337-6115
APN
22119011
CURRENT_STATUS
01
SITE_LOCATION
705 E INDUSTRIAL PARK DR
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\I\INDUSTRIAL PARK\705\PR0540612\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
10/12/2016 10:11:32 PM
QuestysRecordID
3233222
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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Date run 12/9/2015 1:36:34PR SAN JUIN COUNTY ENVERONMENTAL HEA* DEPARTMENT Report #5021 <br />Run by Paget <br />Facility Information as of 12/9/2015 <br />Record Selection Criteria: Facility ID FA0013569 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />Owner ID <br />OW0010689 <br />Owner Name <br />Thomas Asbury <br />Owner DBA <br />SUMMIT ROOFING SERVICES <br />Owner Address <br />3131 BAY MEADOWS CT <br />Phone <br />LIVERMORE, CA 94550 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />510-453-8468 <br />Mailing Address <br />3131 Bay Meadows Ct <br />Location Code <br />Livermore, CA 94550 <br />Care of <br />005 - ELLIOTT, BOB <br />FACILITY FILE INFORMATION <br />Facility lD/CERS ID <br />FA0013569 10184415 <br />Facility Name <br />SUMMIT ROOFING SERVICES <br />Location <br />705 INDUSTRIAL PARK <br />(Circle One) <br />MANTECA, CA 95337-6115 <br />Phone <br />209-825-3042 x <br />Mailing Address <br />705 INDUSTRIAL PARK DR <br />MANTECA, CA 95337-6115 <br />Care of <br />Summit Roofing Services <br />Location Code <br />04 - MANTECA <br />BOS District <br />005 - ELLIOTT, BOB <br />APN <br />22119011 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0022678 <br />Mail Invoices to Account <br />Account Name SUMMIT ROOFING SERVICES <br />Account Balance as of 12/9/2015: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN /Fed Tax ID : <br />New Owner ID : <br />Fax <br />EMail : <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />APPLICANTS SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff:��E <br />COMMENTS: <br />Date I/ <br />$25.00 = Amount Paid Date <br />Amount Paid Date <br />Received by i <br />Date // Account out: Date 1 y// / S <br />I v'vv <br />1�(�5;ktz v�slf �d� <br />Invoice #: <br />(Circle One) <br />drngraMElement <br />Transfer to <br />ActiveAnactve <br />and Description <br />Record ID <br />Employee ID and Name <br />Status <br />New Owner? <br />Delete <br />921 -- HMBP-Reqular-Primary Location <br />PR0521088 <br />EE0000010 - PETER LOMBARDI <br />Active <br />Y N <br />A <br />I D <br />�1SM HW GEN <5 TONSNR <br />PRO540612 <br />EE0009001 - ELENA MANZO <br />Active <br />Y N <br />A <br />I D <br />224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0517725 <br />EE0000000 - HAZ MAT SJC GIES <br />Inactive <br />Y N <br />A <br />I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F <br />PR0517726 <br />EE0009903 - DOUG WILSON <br />Inactive <br />Y N <br />A <br />1 D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG <br />PR0532087 <br />Inactive <br />Y N <br />A <br />I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent <br />of same, acknowledge that all site, anNor project specific, <br />PHSIEHD hourly charges associated with <br />this facility <br />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 <br />Ordinance Codes and/or Standards and State anclor <br />Federal Laws. <br />APPLICANTS SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff:��E <br />COMMENTS: <br />Date I/ <br />$25.00 = Amount Paid Date <br />Amount Paid Date <br />Received by i <br />Date // Account out: Date 1 y// / S <br />I v'vv <br />1�(�5;ktz v�slf �d� <br />Invoice #: <br />
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