Laserfiche WebLink
Date run 12129!2009 10:02:491 SAN JOA' iN COUNTY ENVIRONMENTAL I-IEALT---)EPARTMENT <br /> Run b Report(15021 <br /> y 4� <br /> Facility Information as of 12/29/200 Pagel <br /> Record Selection Criteria: Facility ID FA0018431 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> ter OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> SSN/Fed Tax ID ; <br /> Owner ID OW0015145 New Owner ID <br /> Owner Name NATIONAL CONSTRUCTION RENTALS <br /> Owner DBA NATIONAL CONSTRUCTION RENTALS <br /> Owner Address 6833 32ND ST <br /> NORTH HIGHLANDS, CA 95660 <br /> Home Phone 916-679-6285 <br /> Work/Business Phone Not Specified <br /> Mailing Address 6833 32ND ST <br /> NORTH HIGHLANDS, CA 95660 <br /> Care of RAMIREZ, SIDNEY <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018431 <br /> Facility Name NATIONAL CONSTRUCTION RENTALS INC <br /> Location 12833 S MANTHEY RD <br /> LATHROP, CA 95330 <br /> Phone 916-679-6285 ` <br /> Mailing Address 68-B - p ST V.S�eSS Cep c Y' <br /> C S'I - Z2 2— <br /> Care <br /> Care of RAMIREZ, SIDNEY <br /> Location Code 99- UNINCORPORATED P ;ltPhone <br /> BOS District 003- BESTOLARIDES APN ail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name RAMIREZ, SIDNEY <br /> Title <br /> Day Phone 916-679-6285 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032553 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility ! Account <br /> Account Name NATIONAL CONSTRUCTION RENTALS INC (Circle One) <br /> Account Balance as of 12/29/2009: $210.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK. PR0527223 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> 4255-CHEMICAL TOILETS PRO527616 EE0004045-TED TASIOPOULOS 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 Wit 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 Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. **`` <br /> APPLICANT'S SIGNATURE: Se moo-�\ �+ "�� CQ 1 Date 12/2F5 1 OQ 1 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date I ! <br /> Water System to be TRANSFERED: "$372.00= Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> R <br /> RENS: Date I 1 Account out: r ar_ Date � _I_� ._LO-9._.,_ <br /> COMMENTS: <br /> 1keh-envlenvisionlreports15021.rpt <br />