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Date run 11/27/2017 9:15:32A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by • Pagel <br /> Facility Information as of 11/27/2017 <br /> Record Selection Criteria: Facility ID FA0017288 <br /> Make changestcorrections 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 OW0014129 New Owner ID <br /> Owner Name WILLIAM SARALE <br /> Owner DBA WILLIAM SARALE <br /> Owner Address 14600 E EIGHT MILE RD <br /> LINDEN, CA 95236 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-470-0747 <br /> Mailing Address PO BOX 7960 �V �1 <br /> STOCKTON, CA 95267 <br /> Care of <br /> FACILITY <br /> FILE INFORMATION <br /> Facility I <br /> FA0017288 10186217 � QF,Ez <br /> Facility Name WILLIAM SARALE <br /> Location 14600 E EIGHT MILE RD <br /> LINDEN, CA 95236 <br /> Phone 209470-0747 x <br /> Mailing Address PO BOX 7960 <br /> STOCKTON, CA 95267 <br /> Care of William Sarale <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 09101008 Y� EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name \O r1 <br /> Title / 0 <br /> Day Phone ^� <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION J6 <br /> Account ID AR0030170 41 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name WILLIAM SARALE k O 7l (Circle One) <br /> Account Balance as of 11/27/2017: $0.00 / N2k� <br /> 0 (Circle One) <br /> 7 <br /> TransferActive <br /> Program/Element and Description Re ID Employee ID and Name Status New Owner? <br /> 7 Delteteete ve <br /> 1958-HM-Farm Operations PR0525473 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0530384 EE0001421 -STACY RIVERA Active Y N � <br /> A" > D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0530383 EE9999998-ONE VACANT? Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531890 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 and/or Standards and State andor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: t% Date <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount PaidlLZ'—Li r r/ <br /> Payment Type Check Number Received by <br /> EHD Staff: o Date 1 72 Account out: Date <br /> COMMENTS: <br /> Kl�— <br /> otV3 <br />