Laserfiche WebLink
f [Record <br /> ate run 12!812009 1:40:17PA SAN Jl 1UIN COUNTY ENVIRONMENTAL HEA I DEPARTMENT <br /> un by Report#5021 <br /> k Pagel <br /> Facility Information as of 12/8120u9� <br /> selection Criteria: Facility ID FA0019562 <br /> f <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> SSN/Fed Tax ID <br /> Owner ID OW0016036 ew Owner ID : <br /> Owner Name KING, PETER R <br /> Owner DBA <br /> Owner Address 3835 E MAIN ST <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 3835 E MAIN ST <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019562 <br /> Facility Name KING, PETER R <br /> Location 38 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 3835 E MAIN ST <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 15121052 EMaii: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034816 New.Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility 1 Account <br /> Account Name KING, PETER R (CircleOne) <br /> Account Balance as of 12/8/2009: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? elete i <br /> 1201 -CASE INVESTIGATION-Incorporated City PRO529468 EE0002089-OMRAN SOOD Active Y N A Ul D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSIEHD 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: [late I 1 <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date 1 / <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: Date /,A ! r a9 Account out: ) Date�/ �1 /V9 <br /> COMMENTS: <br /> C 14-5 6`C71 <br /> lleh-envlenvis ionlreports15021.rpt <br />