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Datsnn 2/22/2011 10:37:04AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 05021 <br /> Run by 5290 Pagel <br /> Facility Information as of 2/22/2011 <br /> Record Selection Critena: Facility ID FA0014092 <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 OW0011155 New Owner ID : <br /> Owner Name FONTES, ARLIND ��aloyAfe�/ , rAuk <br /> Owner DBA <br /> Owner Address 2456gg BLOSSOM RD ll_ D - P11are n <br /> THORNTON, CA 95686 <br /> Home Phone Not Specified <br /> Work/Business Phone Ng � <br /> Mailing Addressons - Q.0. pex Gigs <br /> THORNTON, CA 95686 <br /> Care of FtXtIT€S,ARHP D P k O A pY <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014092 <br /> FacilityName pproT=-S,SND 39-292- Q p L <br /> Location 11665 W BARBER RD <br /> THORNTON, CA 95686 <br /> Phone-2g®_7g4-'2W - <br /> MailingAddress PO BOX''SN, -L9• V6)G Cis <br /> THORNTON, CA 95686 <br /> Care of ft3NFFE6,ARL-IWD A(XVI'vIII FrANk <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 00112001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION �1 <br /> Contact Name <br /> Title <br /> Day Phone _ <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0023829 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name FONTES, ARLIND 39-292 (Circle One) <br /> Account Balance as of 2/22/2011: $280.00 <br /> (Circle One) <br /> Transferto Active/InacNe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO529132 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525827 Active Y N A I D <br /> 2795-EMPLOYEE HOUSING-HISTORICAL CAMPSPR0518716 EE0002646-THUY TRAN Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529131 EE0001422-ARIS CACAPIT Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO533453 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State andlor Federal Laws. <br /> APPLICANTS SIGNATURE: Date ! / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: l\L 141'- Date b I I i) Accountout Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />