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Date run 1/10/2006 1:55:34PR SAN JO&N COUNTY ENVEZION31ENTAL HEA> EPARTMENT -)021 <br /> Run by • <br /> Facility Information as of 1/10/20 <br /> Record Selection Criteria: Facility ID FA0007391 <br /> Make changes/corrections in r it <br /> INFORMATION CHANGE(d te)/ <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0001176 New Owner ID <br /> Owner Name CITY OF STOCKTON <br /> Owner DBA <br /> Owner Address 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-937-8377 <br /> Mailing Address 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Care of CITY OF STOCKTON <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007391 <br /> Facility Name STOCKTON FIRE DEPARTMENT <br /> Location 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Phone 209-937-8377 <br /> Mailing Address 425 N ELDORADO <br /> STOCKTON, CA 95202 <br /> Care of GAPTnlN PAUL Beni i r IE Q.`C <br /> Location Code 01 -STOCKTON APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0011124 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name STOCKTON FIRE DEPARTMENT (Circle One) <br /> Account Balance as of 1/10/2006: $70.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4557-MED WASTE LIMITED HAULER PR0506394 EE0000988-KASEY FOLEY Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator 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: "$372.00= Amount Paid Date / ! <br /> Payment Type Check Number Received by <br /> RENS: Date / / Account out: " Date <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />