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Dale run 9/25/2003 4:22:29PA SANJOA COUNTY ENVIRONMENTAL HEAL°DEPARTMENT Reportnsort <br /> Run by <br /> Facility Information as of 9/25/2003 Pagel <br /> Record Selection Criteria: Facility ID FAO012153 <br /> ake changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0CITY OF ST 1' q�New er ID <br /> Owner Name CITY OF STOCK N <br /> Owner DBA <br /> Owner Address 305 N EL DORAD ST STE 200 <br /> STOCKTON, CA 9 02 <br /> Home Phone 209-465-4528 <br /> Work/Business Phone 209-946-9222 <br /> Mailing Address 22 E WEBER AVE #350 <br /> STOCKTON, CA 95202 <br /> Care of CITY OF STOCKTON /7 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012153 0/ <br /> Facility Name SOUTH SHORE PARCEL \ P� <br /> Location WEBER STOCKTON, <br /> STOCKTONN,, CA 95202 <br /> Phone v <br /> Mailing Address 22 E WEBER AVE #350 <br /> STOCKTON, CA 95202 <br /> Care of KITTY WALKER <br /> Location Code <br /> BOB District - <br /> ACCOUNTS RECEIVABLE FILE INFORMATION yl�r7 <br /> Account ID AR0019491 <br /> Mail Invoices to AccountIr 't��G (� <br /> ZM '� � <br /> Account Name SOUTH SHORE PARCEL (Circle one) Account <br /> Account Balance as of 9/25/2003: $0.00 <br /> (Circle One) <br /> Transfer to Actwe/Inactve <br /> Program/Element and Description ecord ID Employee ID and Name Status New Owner! Delete <br /> 2959-NON NPUSEP HZ SITE PRO515450 EE0009488-JEFFREY WONG Active Y N A I D <br /> BILLING antl COMPLIANCE ACKNOWLEDGEMENT: I,the ndersigned ow ralor 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 OW is orm. I also certify that all operations will be performed in accordance with all applkable Ordinace Codes and/or Standards and <br /> Stale 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 a Date <br /> Payment Type ✓ Check Number_ St,(. 31L Received by 2171 <br /> REHS: Date / /_ Account out: Date <br /> COMMENTS: <br /> , ✓� Ili 63 � Wc Jho <br /> Cap�?, <br /> S��OPC1V\N sE v u\s\0" <br /> NEP�SNg <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />