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Date run 12/27/2012 9:58:40A SAN JOIN COUNTY ENVIRONMENTAL HEA10DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12127/2012 <br /> Record Selection Criteria: Facility ID FA0019953 <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 OW0016376 New Owner ID <br /> Owner Name MARCELL FADI <br /> Owner DBA ROYAL WHITE CEMENT CO <br /> Owner Address 8316 E FREEWAY <br /> HOUSTON, TX 77029 <br /> Home Phone Not Specified <br /> Work/Business Phone 713-676-0000 <br /> Mailing Address 8316 E FREEWAY <br /> HOUSTON, TX 77029 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019953 <br /> Facility Name ROYAL WHITE CEMENT CO <br /> Location 610 GILMORE AVE <br /> STOCKTON, CA 95203 <br /> Phone 832-452-4500 x0 <br /> Mailing Address 8316 E FREEWAY <br /> HOUSTON, TX 77029 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 14503001 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 AR0035532 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name MARCELLFADI (Circle One) <br /> Account Balance as of 12/27/2012: $0.00 <br /> (Circle One) <br /> Transfer to Activennactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO530797 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHrPRO533630 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the pony identhed as the OWNER on this form I also cerlgy that all operations will be performed in accordance with all applicable Ordinance Codes andlor Standards and State andfor <br /> Federal Laws. <br /> APPLICANT'S 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 by <br /> REHS: Date / /_ Account out: Date / / <br /> COMMENTS: <br />