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Date run 8/29/2003 10:48:08AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report#5021 <br /> Run by Pagel <br /> Facility Information as,of 8/29/2003 <br /> Record Selection Criteria: Facility ID FA0014676 <br /> oj� ewOwnerlD :e changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATIONOwner ID OW0011685Owner Name RISHWAIN, JOSEPHOwner DBA <br /> Owner Address 14 W ROBINHOOD DSTOCKTON, CA 9520 <br /> Home Phone 209-870-7771 <br /> Work/Business Phone Not Specified <br /> Mailing Address 14 W ROBINHOOD DR <br /> STOCKTON, CA 95207 <br /> Care of RISHWAIN, JOSEPH T <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014676 <br /> Facility Name RISHWAIN, RAYMOND <br /> Location 48 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Phone <br /> Mailing Address 14 W ROBINHOOD DR <br /> STOCKTON, CA 95207 <br /> Care of JOSEPH T RISHWAIN JR <br /> APN: <br /> Location Code 01 -STOCKTON <br /> SIC Code: <br /> BOS District <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024969 ` New Account ID: <br /> Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Facility \�V (Circle One) <br /> Account Name RISHWAIN, RAYMOND \� <br /> Account Balance as of 8/29/2003: / 3Rq ` (Circle One) <br /> Transfer to Active/Inactve <br /> New Owner? Delete <br /> Program/Element and Description <br /> ecord Emplo ee ID an ame Status <br /> 2950-ENVIRON ASSESS <br /> PR 521601 E 0 84-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the under ' -awnsr, rator 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 Ordinace 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 fDDate g / 28-/ q;� <br /> Payment Type ✓ Check Number 91 Z Received by 201f, <br /> REHS: <br /> Date / / Account out: Date <br /> COMMENTS: <br /> 'K4"-s /ILL i::�� <br /> u � <br /> � N <br /> z <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br /> d�a� <br />