Laserfiche WebLink
Date run 7/29/2013 9:39:12AR SAN JOAQUIN COI?NTY&VIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 7/29/2013 Pagel <br /> Record Selection Criteria: Facility ID FA0000131 <br /> Make changes/corrections in RED Ink <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0000112 New Owner ID <br /> Owner Name S &C SEPTIC SERVICE INC <br /> Owner DBA G & C SEPTIC TANK SERVICE <br /> Owner Address 12851 STOCKTON BLVD <br /> GALT, CA 95632 <br /> Home Phone 209-368-3933 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 127 <br /> GALT, CA 95632 <br /> Care of SHON OR CONNIE STEELE <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0000131 <br /> Facility Name G & C SEPTIC TANK TRUCK <br /> Location 12851 STOCKTON BLVD <br /> GALT, CA 95632 <br /> Phone 209-368-3933 <br /> Mailing Address PO BOX 127 <br /> GALT, CA 956320127 <br /> Care of SHON OR CONNIE STEELE <br /> Location Code 98 - OUT OF COUNTY Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name STEELE, RICK <br /> Title TRUCK#1 <br /> Day Phone 209-368-3933 <br /> Night Phone 209-368-3933 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000130 New Account ID: <br /> Mail invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name G &C SEPTIC TANK TRUCK (ClydeOne) <br /> Account Balance as of 7/29/2013: $0.00 <br /> (Circle One) <br /> Transfer to ActivfAnadve <br /> ProgrannElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PR0420107 EE0005366-LISA MEDINA Inactiv( Y N A I D <br /> 4244-PUMPER TRUCK —PR0420106 EE0005944-MICHAEL ESCOTTO Active Y N A (T) D <br /> 4244-PUMPER TRUCK PRO420130 EE0005944-MICHAEL ESCOTTO Active Y N A I D <br /> 4244-PUMPER TRUCK PRO535399 EE0005944-MICHAEL ESCOTTO Active Y N A 1 D <br /> 4246-PUMPER YARD PRO536479 EE0005944-MICHAEL ESCOTTO Active,[ Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the underagned owner,operator or agent of same,acknowledge that all site,and/or project specifc,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party is entlfed as the OWNER ontA form I also certify ffi tell operations will be performed in accordance with all applicable OMinance Codes andbr Standards andState ands <br /> yyF'"ederal Laws <br /> /t A . <br /> PPLICANTS SIGNATURE: ALJ f/l. lDate 2-1 l 3 <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> PaymentChe k umber Rete' e <br /> REHS:tr'dfi'Z > C Date Account out: _ Data <br /> � <br /> COMMENTS' �r M 17 7 x��- <br /> 00 <br /> 7:j G fJ drFJi%�s P�`f2c�d8 <br />