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Date ran 12/18/2017 12:54:08F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repo #5021 <br /> Run by Pagel <br /> Facility Information as of 12/18/2017 <br /> Record Selection Criteria: Facility ID FA0014299 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0011353 New Owner ID <br /> Owner Name CARY & LYNNETTE PARAFIN <br /> Owner DBA FLUID MANUFACTURING <br /> Owner Address 804 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-7864484 <br /> Mailing Address 804 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION / <br /> Facility ID/CERS ID FA0014299 10184593 <br /> Facility Name FLUID MANUFACTURING <br /> Location 804 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Phone 209-334-6144 x0 <br /> Mailing Address 804 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Care of PETER PARAFIN <br /> Location Code Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 04917037 EMa <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION I /_ 1 <br /> Contact Name /�'l �/ <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION 1 ()UN <br /> Account ID AR0024285 '(/ New Account ID: <br /> Mail Invoices to Account �/( b Mail Invoices to: Owner / Facility / Account <br /> Account Name FLUID <br /> MANUF TURING (Circle One) <br /> Account Balance as of 12/18/2017: $ .00 <br /> (Circle One) <br /> Transfer to ActivennicNe <br /> PrograMElement and Description Record ID Employee ID and Name Status New Omer' Delete <br /> 1921 -HMBP-Regular-Primary Location PRO621263 EE0008709-JAMIE LIMA Active Y N AI D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO519174 EE0000000-HAZ MAT SJC OES Inactive Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533059 Inactive 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,PHSIEHD hourly charges associated with this facility <br /> 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 Ordinance Codes anNor Standards and State and/or <br /> 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 Ty{�e Check Number Received by <br /> EHD Staff: l 1 VV�_(1Date / /�Z Account out: Date <br /> COMMENTS'. Invoice If: <br />