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Date run 2/2/2015 8:24:26AM SAN JOAQUI[N COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Page <br /> Facility Information as of 2/2/2015 <br /> Record Selection Criteria: Facility ID FA001 7527 <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: 'I SSN1 Fed Tax ID <br /> Owner ID OW0014368 New Owner ID <br /> Owner Name JACK BOZZANO <br /> Owner DBA JACK BOZZANO <br /> Owner Address 2797 N ARATA WAY <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 2797 N ARATA WAY <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0017527 <br /> Facility Name JACK BOZZANO <br /> Location 0 SE-Bbk9V4+N-1800 FT ARATA 100 RD <br /> STOCKTON, CA 95215 <br /> Phone 209-483-1115 x0 <br /> Mailing Address 2797 N ARATA WAY <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030409 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner I Facility ! Account <br /> Account Name JACK BOZZANO (Circle One) <br /> Account Balance as of 21212015: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> ProgramlEiement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525712 EED000006-HAZA SAEED Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532288 Inactive Y N A l D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,ari project specific,PHSrEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this farm. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andror Standards and State andlor <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date I f <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date f f <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received b <br /> R€HS: Date 1 I Account out: - Date <br /> COMMENTS: <br />