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Date run 8/28/2020 3:07:15PK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/28/2020 <br /> Record Selection Criteria: Facility ID FA0015929 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 4 SSN/Fed Tax ID <br /> Owner ID OW0005924 New Owner ID <br /> Owner Name PORT OF STOCKTON <br /> Owner DBA <br /> OwnerAddress 2201 W WASHINGTON ST <br /> STOCKTON, CA 95203 <br /> Work/Business Phone 209-946-1914 <br /> Alternative Phone 209-946-0246 <br /> Mailing Address PO BOX 2089 <br /> STOCKTON, CA 95201 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0015929 <br /> Facility Name PORT OF STOCKTON BLDG#16 <br /> Location 305 FYFFE AVE BLDG 16 <br /> STOCKTON, CA 95201 <br /> Phone <br /> Mailing Address PO BOX 2089 <br /> STOCKTON, CA 95201 <br /> Care of PORT OF STOCKTON BLDG#16 <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name TYSON FULMER <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027726 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ENV ON AL RISK SERVICES CORP (Circle One) <br /> Account Balance as of 8/28/2 0: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? fete <br /> 2960-RWQCB LEAD AGENCY CLEAN UP SITE PR0523599 EE0000997-HARLIN KNOLL Active Y N A 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 facility <br /> 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 Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFEI> D: Amount Paid Date <br /> Payment Type IC#hNu, berReceived <br /> EHD Staff: ate / / Account out: DateCOMMENTS: Invoice#: <br />