Laserfiche WebLink
Date run, "1112912004 3:17:13F SAN'90A' IN COUNTY ENVIRONMENTAL HEAL---DPagel Report#5021 <br /> } Run by �.�� <br /> Facility Information as of 11/29/20 <br /> Record Selection Criteria: Facility ID FA0014109 <br /> / Make anges/corrections in RED ink or pencil. <br /> / INFORMATION CHANGE(date) <br /> 1 OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011171 New Owner ID <br /> Owner Name HOUSECALLS HOME HEALT A NCY <br /> Owner DBA HOUSECALLS HOME HEALTH ' GENCY <br /> Owner Address 4558 FEATHER RIVER DR#C 1 p yi <br /> STOCKTON, CA 95219 5 <br /> Home Phone 209-952-8015 <br /> W ork/Business Phone 209-887-9332 <br /> Mailing Address 4568 FEATHER RIVER DR, STE C <br /> STOCKTON, CA 95219 <br /> Care of SAXTON, CURTIS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014109 <br /> Facility Name HOUSECALLS HOME HEALTH AGENCY <br /> Location 4568 FEATHER RIVER DRC <br /> STOCKTON, CA 95219 <br /> Phone 209-952-8015 <br /> Mailing Address 4568 FEATHER RIVER DR, STE Coi, <br /> STOCKTON, CA 95219 GA — 7 p <br /> Care of SAXTON, CURTIS <br /> Location Code 01 - STOCKTON APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0023857 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility 1 Account <br /> Account Name HOUSECALLS HOME HEALTH AGENCY (Circle One) <br /> Account Balance as of 1112912004: $70.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4557-MED WASTE LIMITED HAULER PRO518736 EED000988-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,PHSlEHD 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 andlor Federat Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date I ! <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date ! / <br /> Payment Type Check Number Received by <br /> RENS: Date I I Account out: LJl g Date -��10 ) <br /> COMMENTS: <br /> Fk&4 <br /> I <br /> G:15021.rpt i <br />