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Report <br /> )ate run 9/14/01 12:26:39PM SAN JO'XdUIN COUNTY PUBLIC HEALTH SERVI�3 Page #: 1 <br /> Run by Facility Information as of 9/14/01 <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: HUGHES, J P <br /> Owner DBA: AMERICAN MOULDING &MILLWORK <br /> Owner Address: 288 ROOTHILL DR <br /> SUTTER CREEK, CA 95685 <br /> Home Phone: 209-267-0433 <br /> Work/Business Phone: 209-946-5880 <br /> Mailing Address: 2801 WEST LANE <br /> STOCKTON, CA 95208 <br /> Care of: J P HUGHES <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0004032 <br /> Facility Name: AMERICAN MOULDING & MILLWORK <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: J P HUGHES <br /> APN: <br /> Location Code: 01 -STOCKTON SIC Code: <br /> BOS District: 002- MARENCO, DARIO <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> New Account ID: <br /> Account ID: AR0003672 Mail Invoices to: Owner/Facility/Account <br /> Mail Invoices to: Facility (Circle One) <br /> Account Name: AMERICAN MOULDING & MILLWORK <br /> Account Balance as of 9/14/01: $0.00 (Circle one) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name <br /> Status New Owner? Delete <br /> Active Y N A I D <br /> T295 ENVIRON ASSESS PR0009016 EE0000756-CAROL OZ Y N A I <br /> PR0504943 EE0000756-CAROL OZ Active <br /> 2951 -UGT-CAP Active Y N A <br /> 2953-LCL HW CLEANUP SITE PR0505272 EE0000756-CAROL OZ <br /> ite,and/or <br /> ject <br /> ated <br /> fBILLING acility or activitylwiillll ble billed to he party identified ed as the OWNER oMENT: I the lgned n this owner, <br /> I also certify that all operations wilrator or agent of same, l performed ge that all in accordance owith all applicable/O diinace Codes and/or Sta'ndardstandis <br /> State and/or Federal Laws. <br /> Date <br /> APPLICANT'S SIGNATURE: Amount Paid Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= <br /> Check Number Received by <br /> Payment Type Date <br /> REHS: <br /> Account out: <br /> COMMENTS: <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />