Laserfiche WebLink
Date run 5/12/2009 10:43:41AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/1212009 <br /> Record Selection Criteria. Facility ID FA0019638 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0016097 New Owner ID <br /> Owner Name PADILLA, MILA S <br /> Owner DBA <br /> Owner-Address PO BOX 1036 <br /> TRACY, CA 953781036 <br /> Home Phone 209-832-7780 <br /> WoWBusiness Phone Not Specified <br /> Mailing Address PO BOX 1036 <br /> TRACY, CA 953781036 <br /> Care of ZARAKANI, ANDY <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019638 <br /> Facility Name PADILLA PROPERTY <br /> Location 14749 N THORNTON RD <br /> LODI, CA 952429509 <br /> Phone 209-832-7780 <br /> Mailing Address PO BOX 1036 <br /> TRACY, CA 953781036 <br /> Care of ZARAKANI, ANDY <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 05515026 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034970 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name PADILLA PROPERTY (Circle One) <br /> Account Balance as of 5/12/2009: $0.00 <br /> (Circle One) <br /> Transfer to ActiveBnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PRO529753 EE0000684-MICHAEL INFURNA 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 spec,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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />