Laserfiche WebLink
11 <br /> Date run 10/11/2005 9:28:27A SAN JOAr �N COUNTY ENVIRONMENTAL 11 HEAL/ `DEPARTMENT Report x5021 <br /> _ <br /> Run by <br /> Facility Information as of 10/11/2005 Pagel <br /> a. <br /> Record Selection Criteria: Facility ID FA0016119 <br /> . Make c�anges/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0006120 New Owner ID <br /> Owner Name ST JOSEPH'S MEDICAL CENTER <br /> Owner DBA I <br /> Owner Address 1800 N CALIFORNIA ST <br /> STOCKTON, CA 95204 ; <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified '. <br /> Mailing Address PO BOX 213008 <br /> STOCKTON, CA 952139008 <br /> Care of <br /> FACILITY FILE INFORMATION � <br /> Facility ID FA0016119 <br /> Facility Name CATHOLIC HEALTH CARE <br /> Location 1800 N CALIIFORNIA ST j <br /> STOCKTON, CA-95204 <br /> Phone 209 467-6402 <br /> Mailing Address 1800 N CALIFORNIA ST <br /> STOCKTON,CA 95204 4 <br /> Care of SPRING, TERRY <br /> Location Code 01 - STOCKTON APN 12718044 <br /> BOS District 002 -MARENCO, DARIO SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0028158 New Account ID <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CONDOR EART ECHNOLOGIES INC (crreone) <br /> Account Balance as of 10/11/2005: <br /> Ilt (Circle One) <br /> Transferto Active/Inactve <br /> Program/Element and Desorption Record ID Employee ID and Name i Status New Owner' Delete <br /> t 2950-ENVIRON ASSESS> PRO523958 EE0000684-MICHAEL INFU1t2NA Ove 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 assouated with this <br /> faculty or activity wig be billed to the party,ideMRed as the OWNER on this form. I also certify Nal all operations will be Performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: '.�I Date / / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / ! <br /> Water System to be T SF RED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Receive b <br /> REHS: Datei" / Os Account ouC ��. Date 11 15 <br /> COMMENTS: 'I`` <br /> f <br /> I <br /> l� <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt , <br />