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Date run 2/25/2015 4:53:42PA SAN JO `UIN COUNTY ENVIRONMENTAL HEA- -'H DEPARTMENT Report#5021 <br /> Run by 111110" Pagel <br /> Facility Information as of 2/25/2( � <br /> Record Selection Criteria: Facility ID FA0006789 <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: 1 SSN/Fed Tax 10 <br /> Owner ID OW0005573 New Owner ID <br /> Owner Name City Of Escalon <br /> Owner DBA CITY OF ESCALON POLICE DEPT <br /> Owner Address 2060 MCHENRY AVE <br /> ESCALON, CA 95320 <br /> Home Phone 209-838-7093 <br /> Work/Business Phone 209-691-7400 <br /> Mailing Address 2060 McHenry Ave <br /> ESCALON, CA 95320 <br /> Care of WALT MURKEN, CHIEF OF POLICE <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0006789 10182143 <br /> Facility Name CITY OF ESCALON POLICE DEPT <br /> Location 1855 E COLEY AVE <br /> ESCALON, CA 95320 <br /> Phone 209-691-7400 X <br /> Mailing Address 2060 McHenry Ave <br /> ESCALON, CA 95320 <br /> Care of City Of Escalon <br /> Location Code 06- ESCALON Alt Phone <br /> Bos District 004-WINN, CHARLES Fax <br /> APN 22715218 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name WALT MURKEN, CHIEF OF POL <br /> Title <br /> Day Phone 209-838-7093 <br /> Night Phone 209-838-7093 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0009356 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CITY OF ESCALON POLICE DEPT (Circle One) <br /> Account Balance as of 2/25/2015: $120.00 <br /> M u-0 \ Cinal One) <br /> Transfer to ActivellnacNe <br /> Progrannieement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1471 -TYPE I-TEMP HOLDING(</=24 HRS) PRO505463 EE0005362-NICHOLAS WIESEMAN Inactive Y N A I D <br /> 1920-HMBP-Common Maftdala PR0539092 EE0002474-MICHAEL PARISSI Active Y N A (IJ) D <br /> 2840- MPTFAC <1,320 GAL PRO528843 EE0002670-MUNIAPPA NAIDU Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andror project spec,PHSIEHD hourly charges emaciated with this facility <br /> or activity will be bilbd to the party identified as the OWNER on this form I also codify that all operations will be performed in accordance with all applicable Ordinance Codes andbr Standards and State ardor <br /> Federal Laws. �M �1 1A( T S <br /> APPLICANTS SIGNATURE: M4-( L- t Date Z <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 Recel y <br /> RENS: �1-fc, Date_/_t_/ �I&_ Account out: Date T" / 73 / �s <br /> COMMENTS: <br /> P cats� R-�J15� ���.-�� �=G�4-����G- .�/✓v �cam=. <br />