Laserfiche WebLink
Date run 4/23/2002 2:15:54PN SAN J017"IN COUNTY'ENVIRONMENTAL HEAI/0"'NDEPARTMENT Report#5021 <br /> Run by I'_ i Pagel <br /> Facility Information as of 4/23/2002 <br /> Record Selection Criteria: Facility ID FA0003605 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0001008 New Owner ID <br /> Owner Name STATE OF CALIFORNIA <br /> Owner DBA CAL TRANS-DOT <br /> Owner Address 1976 E CHARTER WAY <br /> STOCKTON, CA 95205 <br /> Home Phone 209-948-7409 <br /> Work/Business Phone Not Specified <br /> Mailing Address PETE NUNES <br /> STOCKTON, CA 95205 <br /> i <br /> Care of STATE OF CALIF/CAL TRANS-DOT <br /> FACILITY FILE INFORMATION <br /> I <br /> Facility ID FA0003605 <br /> Facility Name CAL TRANS DIST 10 TRACY MAINT i <br /> Location 2005 KROHN RD <br /> TRACY, CA 95376 <br /> Phone 209-835-6779 <br /> Mailing Address 315 DEPOT RD <br /> IONE, CA 95640 <br /> Care of CHRIS MARTIN <br /> Location Code 03-TRACY APN: <br /> BOS District 005- BEDFORD, LYNN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003183 NewAcoount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner ! Facility / Account <br /> Account Name CAL TRANS DIST 10 TRACY MAINT (Circle One) <br /> Account Balance as of 412312002: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514041 EE0000451 -STEVE SASSON Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512091 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1184) PR0231544 EEO 0451 -STEVE SASSON Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509803 EE0000000-HAZ MAT SJC OES Active 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 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 Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> i <br /> APPLICANT'S SIGNATURE: Date ! I r <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 Received by <br /> t <br /> RENS: Date ! / Accoulnt out: Date / ! <br /> COMMENTS: <br /> 11Phs-ehsgl-ntlappslEnvisionslReports15021.rpt <br />