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Date run 10/11/2005 9:31:43,4 SAN JO N COUNTY ENVIRONMENTAL HEAIWEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/11/2005 <br /> Record Selection Criteria. Facility ID FA0014788 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0009358 New Owner ID <br /> Owner Name CHANDLER, WILEY <br /> Owner DBA <br /> Owner Address PO BOX 507 <br /> STOCKTON, CA 95201 <br /> Home Phone 209-943-2004 <br /> Work/Business Phone 209-298-7520 <br /> Mailing Address PO BOX 507 <br /> STOCKTON, CA 95201 <br /> Care of CHANDLER, WILEY <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014788 <br /> Facility Name DEL MONTE AREA E(FORMER)WHRHS(CU <br /> Location 110 N FILBERT ST <br /> STOCKTON, CA 95205 <br /> Phone 209-518-2772 <br /> Mailing Address PO BOX 507 <br /> STOCKTON, CA 952010507 <br /> Care of CHANDLER, WILEY <br /> Location Code 01 -STOCKTON APN: <br /> SOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025179 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name DEL MONTE A E(FORMER)WHRHS(CURR) (Circle One) <br /> Account Balance as of 10/11/2005: $ <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> RAriAtIsBESS PRO621777 EE0000684-MICHAEL INFURNA AcKve Y N A I D <br /> • <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 associated with this <br /> facility or activity volt 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 /> State andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be T NSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Rec 21 <br /> by _ <br /> REHS: Date !O l /! l D Account out: Date—LILI—OLIZLIL <br /> COMMENTS: <br /> \\phs-e hsq I-nt\apps\e nvisions\reports\5021.rpt <br />