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Date dun 10/12/2018 9:15:43A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 115021 <br /> Run by Pagel <br /> Facility Information as of 10/12/2018 <br /> Record Selection Crania: Facility ID FA0010040 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Numberof facilities forthis owner: 1 SSN/Fed Tax 10 : <br /> Owner ID OW0008040 Case Number: H06314 New Owner ID <br /> Owner Name FRANK STONEBARGER <br /> Owner DBA STONEBARGER WALNUT HULLING <br /> OwnerAddress 8408 N BEECHER RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/BusinessPhone 209-481-6547 <br /> Mailing Address 8408 N BEECHER RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0010040 10183151 <br /> Facility Name STONEBARGER WALNUT HULLING <br /> Location 8299 N BEECHER RD <br /> STOCKTON, CA 95215 <br /> Phone 209-481-6547 x <br /> Mailing Address 8408 N BEECHER RD <br /> STOCKTON, CA 95215 <br /> Care of Glenn Goold <br /> Location Code 99-UNINCORPORATED A Alt Phone <br /> BOS District 004-WINN, CHARLES Fax <br /> APN 08914013 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017040 NewAccount ID: <br /> Mail Invoices to Account ' 1 Mail Invoices to: Owner / Facility / Account <br /> Account Name FrankStonebar lm�Y (CirdeOne) <br /> Account Balance as of 10/12/2018: $ .00 <br /> (Circle One) <br /> Transfer to AdiWnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0520039 EE0008709-JAMIE LIMA Active Y N A ( I / D <br /> Ill 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512328 EE0000000-HAZ MAT SJC DES InY N A 0 D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO510040 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532849 Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and'or project specific,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party Identified as the OWNER on this forth. I also candy that all operations will be performed in accordance with all applicable Ordinance Codes anclor Standards and State ani <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Tye Check Number Received <br /> EHD Sta � / y <br /> Date I / Account out: Date �� l lyl� <br /> 6n COMMENTS: I/(� (� /,�Q f/'� 1m yy� <br /> v ' 'ss no LUI1N .1 n t/p�l e/1� f7'U I . Invoice#: <br />