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Date mn 3/4/2014 8:58:03AM SAN JOA,..�IN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Repod xsort <br /> Run by Pagot <br /> Facility Information as of 3/1 <br /> Record Selection Criteria: Facility ID FA0016973 <br /> Make changes/corrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013814 New Owner ID <br /> Owner Name EDDIE & JUDY PIAZZA <br /> owner DBA EDDIE & JUDY PIAZZA <br /> Owner Address 1155 GILLIS RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1155 GILLIS RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0016973 10,185,703 <br /> Facility Name EDDIE & JUDY PIAZZA <br /> Location 1155 GILLIS RD <br /> STOCKTON, CA 95215 <br /> Phone 209-466-7118 x0 <br /> Mailing Address 1155 GILLIS RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 17329017 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029855 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name EDDIE &JUDY PIAZZA (Circle One) <br /> Account Balance as of 3/4/2014: $53.00 <br /> (Circle One) <br /> Transfer to Activennactve <br /> Program/Element and Description Record ID Employee ID Status New Ovmer? to <br /> 1958-HM-Farm Operations PR0525158 Active Y N A I D <br /> 2840-AST EXEMPT FAC X1,320 GAL PR05306 EE0000753-WILLY NG Active,l Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532 Inactive Y N A I D <br /> BILLING an!COMPLIANCE ACKNOWLEDGEMENT: 1,the undersign!owner,operator ora -t of same,acknowledge that all site,andror project specific,PH&EHD hourly charges associated with this facility <br /> or activity will be billed to the party idenliged as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes endor Standards and State andror <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 Type Check Number Received b <br /> REHS: `pf r 4 C Date 2j 11 4 Account out: Date <br /> COMMENTS: T 1 <br />