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Date run 7/12/2018 3:26:27Pfv SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 7/12/2018 <br />Record Selection Criteria: Facility ID <br />FA0019195 <br />Make changestcorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION Number of facilities for this owner : 10 SSN / Fed Tax ID <br />Owner ID <br />OW0012870 New Owner ID <br />Owner Name <br />CITY OF STOCKTON <br />Owner DBA <br />OwnerAddress <br />2500 NAVY DR <br />STOCKTON, CA 95206 <br />Home Phone <br />209-937-8708 <br />Work/Business Phone <br />209-937-8341 <br />Mailing Address <br />425 N. EL DORADO ST. <br />STOCKTON, CA 95202 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0019195 10187093 <br />Facility Nam <br />Cji Hao <br />Location <br />8477 N el dorado ST e <br />STOCKTON, CA 95210 <br />Phone <br />209-937-8708 x <br />Mailing Address <br />2500 NAVY DR <br />STOCKTON, CA 95206 <br />Care of <br />City of Stockton - MUD- EI Dorado and Moshe <br />Location Code <br />01-STOCKTON Alt Phone <br />BOS District <br />003 - BESTOLARIDES, STEVE Fax <br />APN <br />07947001 Entail: <br />EMERGENCY NOTIFICATION <br />CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID <br />AR0034160 New Account ID: <br />Mail Invoices to <br />Account Mail Invoices to: Owner / Facility / Account <br />Account Name <br />CITY OF STOCKTON (Circle One) <br />Account Balance as of 7/12/2018: $0.00 <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1920 - HMBP-Common Materials PR0537206 EE0008709 - JAMIE LIMA Active Y N A I D <br />2840 -AST EXEMPT FAC < 1,320 GAL PR0528523 EE9999998 - ONE VACANT1 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, PHS/EHD 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 andror <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Typ��jj Check Number Received by Jn <br />EHD Staff: l_�� �- Date / / Account out: Date �/ /_li <br />GCOMMENTS: � oyv'lovoice #: <br />G wo <br />