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Date run 6/16/2004 4:25:55PN SAN JUIN COUNTY ENVIRONMENTAL HE H DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 8) 4 <br /> Record Selection Criteria: Facility ID FA0000673 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0000538 New Owner ID <br /> Owner Name RIPON CITY OF <br /> Owner DBA <br /> Owner Address 259 N W ILMA <br /> RIPON, CA 95366 <br /> Home Phone 209-599-2108 <br /> Work/Business Phone Not Specified <br /> Mailing Address 259 N WILMA <br /> RIPON, CA 95366 <br /> Care of CITY OF RIPON <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000673 <br /> Facility Name CITY OF RIPON <br /> Location 1210 S VERA AVE <br /> RIPON, CA 95366 <br /> Phone 209-599-2108 <br /> Mailing Address 259 N W ILMA <br /> RIPON, CA 95366 <br /> Care of CITY OF RIPON <br /> Location Code 05 - RIPON APN:25933007 <br /> BOS District 005-ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000672 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CITY OF RIPON (Circle One) <br /> Account Balance as of 8/16/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inacwe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVI RON ASSESS PR0505712 EE0007479-RON ROWE Active Y N A I D <br /> 4423-REFUSE VEHICLES PRO440026 EE0005366-LISA MEDINA Active Y N A I D <br /> 4430-SOLID WASTE CIA SITE PR0515731 EE0001699-JOHNNY YOAKUM 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 Ordiruce 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: '$155.00= Amount Paid Date / / <br /> Payment Type Check Number Received by <br /> RENS: Date / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />