Laserfiche WebLink
Date run 8/21/2006 3:05:32PR SAN JUIN COUNTY FNiURONMENTAL HEAOH DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 8/21/2 <br /> Record Selection Criteria: Facility ID FA0004032 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> ..,.�' OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002967 New Owner ID <br /> Owner Name AMERICAN MOULDING AND MILLWORK <br /> Owner DBA <br /> Owner Address 813 E MAIN ST <br /> SANFORD, NC 27332 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-946-5880 <br /> Mailing Address 516 NEELY CT <br /> SANFORD, NC 27332 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Site Mitigation Facility <br /> Facility ID FA0004032 Ite Mitigation Facility <br /> Facility Name FRMR AMERICAN MOULDING &MILLWORKS <br /> Location 2801 WEST LN <br /> STOCKTON, CA 95208 <br /> Phone 209-946-5880 <br /> Mailing Address 2801 WEST LANE <br /> STOCKTON, CA 95208 <br /> Care of MILL CREEK DEVELOPMENT-WEST LN <br /> Location Code 99- UNINCORPORATED AREA APN 11709001 <br /> BOS District 002 -MARENCO, DARIO SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003672 NewACcount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name MACTEC ENGINEERING&CONSULTING INC (Circle One) <br /> Account Balance as of 8/21/2006: $0.00 <br /> (Circe One) <br /> Transfer to gc[ivelinactve <br /> New Owner? Delete <br /> PmgramlElement and Description Record ID Employee ID and Name Salus <br /> 2951 -UGT-CAP PRO504943 EE0000756-CAROL OZ Inactive Y N A I D <br /> 2953-LCL HW CLEANUP SITE PRO505272 EE0000756-CAROL OZ Inactive Y N A I D <br /> <'2960-RWQCB SITE PR0009016 EE0009488-JEFFREY WONG Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge[hat 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 /> Stale andmor Federal Laws. 1 <br /> APPLICANTS SIGNATURE: S Q-2 C'A Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Dake <br /> Water System to be TRANSFERED: _'$372.00=— Amount Paid Date_/ /_ <br /> Payment Type Check Number Rece' d by <br /> REHS: Date_/ / Account out: rT Date S, / 2—U bL <br /> COMMENTS: <br /> \\ohs-e hsgl-nt\a pps\envisions\reports\5021.rpt <br />