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Record Selection Criteria: Facility ID FA0009032 <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION <br />Owner ID: OW0007032 Case Number: H00437 New Owner ID <br />Owner Name: WILL MORET, ; RALPH MEC -Ms <br />Owner DBA: <br />Owner Address: <br />Home Phone: Not Specified <br />Work/Bussness Phone: 209-599-3767 <br />Mailing Address: 212 E MAIN ST <br />Care of: <br />FACILITY FILE INFORMATION <br />Facility ID: <br />r rlr <br />Facility Name: <br />RIPON AUTO CENTER INC <br />Date run : <br />7/26/00 8:31:25AM <br />SAOOAQUIN COUNTY PUBLIC HEALTH SFISICES <br />Report #: <br />0002 <br />Run by : <br />AYOUNGBLOOD <br />Facility Information as of 7/26/00 <br />Page #: <br />1 <br />Record Selection Criteria: Facility ID FA0009032 <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION <br />Owner ID: OW0007032 Case Number: H00437 New Owner ID <br />Owner Name: WILL MORET, ; RALPH MEC -Ms <br />Owner DBA: <br />Owner Address: <br />Home Phone: Not Specified <br />Work/Bussness Phone: 209-599-3767 <br />Mailing Address: 212 E MAIN ST <br />Care of: <br />FACILITY FILE INFORMATION <br />Facility ID: <br />FA0009032 <br />Facility Name: <br />RIPON AUTO CENTER INC <br />Location: <br />212 E MAIN ST <br />D <br />RIPON, CA 95366 20 <br />Phone: <br />209-599-3767 <br />Mailing Address: 212 E MAIN ST <br />Care of: WILL MORET <br />Location Code: <br />BOS District: 005 - CABRAL, ROBERT <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />APN: 259-390-17 <br />SIC Code: <br />Account ID: AR0016032 New Account ID:: <br />Mail Invoices to: Account Mail Invoices to: Owner / Facility / Account <br />Account Name: RIPON AUTO CENTER INC (Circle One) <br />Account Balance as of 7/26/00: $0.00 <br />(Circle One) <br />UST(s) Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE FI <br />PR0509032 <br />EE0000000 - SJC OES <br />Active <br />Y <br />N <br />A I <br />D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0511320 <br />EE0000000 - SJC OES <br />Active <br />Y <br />N <br />A I <br />D <br />2220 - SM HW GEN <5 TONS/YR <br />PR0513596 <br />EE0007289 - YOUNGBLOOD <br />Active <br />Y <br />N <br />A I <br />D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1, the undersigned owner, operator or agent of same, acknowledge that all site, and/or <br />project specific, PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this <br />form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal <br />Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />grogram Records to be TRANSFERED: * $0.00 = Amount Paid Date <br />Nater System to be TRANSFERED: ' $150.00 = Amount Paid Date <br />'ayment Type Check Number Receipt Number Received by <br />:ZEHS: Date / / Account out: i� ? Date Sf'� / 7 <br />'OMMENTS:a <br />1.0.0.89.00 <br />