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Date run 11/24/2014 11:25:371 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report#521 <br /> Pagel <br /> Run by Facility Information as of 11/24/2014 <br /> Record Selection Criteria:, Facility ID FA'001 7088 _ <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 1 Fed Tax ID <br /> Owner ID OW0013929 New Owner ID <br /> Owner Name GERALD GIUDICE <br /> Owner DBA GERALD GIUDICE <br /> Owner Address 5577 N CONFER RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone 209_931-4245 <br /> Mailing Address 5577 N CONFER RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID f CERS ID FA0017088 10185879 <br /> Facility Name GERALD GIUDICE <br /> Location 5577 N CONFER RD <br /> STOCKTON, CA 95215 <br /> Phone 209-931-4245 x <br /> Mailing Address 5577 N CONFER RD <br /> STOCKTON, CA 95215 <br /> Care of gerald giudice <br /> Location Code Alt Phone <br /> BOS District Fax <br /> All 08923001 EMaii: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029970 New Account Il <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility J Account <br /> Account Name GERALD GIUDICE (Circle One} <br /> Account Balance as of 11/24/2014: $0.00 <br /> (Circle One) <br /> Transfer to Actnrellnaoroe <br /> PrograrrVElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525273 Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0530557 EE0009488-JEFFREY WONG Active Y N A t D <br /> 2830-AST FAC -SPCC EXEMPT PR0530556 EE0009488-JEFFREY WONG Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532035 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT 1.the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specific,f HSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER an this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and+or Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE Date J 1 <br /> Program Records to be TRANSFERFD '$25.00= Amount Paid Date f 1 <br /> Water System to be TRANSFFRED, Amount Paid Date 1 I <br /> Payment Type Check Number Received by <br /> REHS: Date 1 f Account out: Date I I <br /> COMMENTS: <br />