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Date run 3/14/2014 8:46:41AR SAN J0,,i COUNTY ENVIRONMENTAL HEAT JDEPARTMENT Report#5021 <br /> Run by �./ Paget <br /> Facility Information as of 3/14/2014 <br /> Record Selection Criteria: Facility ID FA0016973 <br /> Make changesicorrections 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 ID/CERS ID FA0016973 10185703 <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 Entail: <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 O V d New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name EDDIE D (Circle One) <br /> Account Balance as of 3/14/2014: $53.00 <br /> (Circle One) <br /> Transfertoive <br /> Acllte <br /> ProgramlElementartl Description Record ID Employee ID end Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525158 Active Y N AD <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO530609 EE0000753-WILLY NG Active,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532132 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT'. I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project spec,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 andor Standards and State andor <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 T Check Number Receiv d by <br /> REHS: �{ l ll A �V-e J Date�/� / Account out: Date 3 I l <br /> COMMENTS: <br /> �zeCQ PUt-,u Al\e 311311'-1 XrV4-\ 946I'Jn► <br /> 323 - 3&t O - O{A' w&f CO t' rN 5e.. tvI f 6 � -rL - OWr\G'' . � <br /> La 1�9 1 t, <br /> 44^0—i V4,6 Say, M n, Soo�ktrs i�#4. <br />