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I <br /> Daterun 2112/2003 8:33:36AK SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 2/12/20 <br /> Record Selection Criteria: Facility ID FA0014370 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0000353 New Owner ID <br /> Owner Name MANTECA, CITY OF <br /> Owner DBA <br /> Owner Address 1001 W CENTER ST <br /> MANTECA, CA 95337 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1001 W CENTER ST <br /> MANTECA, CA 95337 <br /> Care of ATTN: PURCHASING ASST <br /> FACILITY FILE INFORMATION <br /> Facility ID FAO <br /> Facility Nam ANTECA CORP YARD <br /> Lo Ion 205 E W ETMORE AVE <br /> MANTECA, CA 9533 �-aa,/, <br /> Phone V C-�- 1l/✓Yli)L-CJ <br /> Mailing Address 1001 W CENTER <br /> MANTECA, CA 95337 <br /> Care of <br /> Location Code 04 - MANTECA APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024426 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MANTECA CORP YARD (Circle One) <br /> Account Balance as of 2/12/2003: $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 /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourlycharges 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 /> Stale and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: _-IUr�/'N�O✓, 'UT/j✓Q^Q/� l � soQ 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 Receivecl by z <br /> RENS: Date / / Account out: 116 Date_ — J,J <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />