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Datemn ,11/1/2016 7:58:15AK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 11/1/2016 <br /> Record Selection Criteria: Facility ID FA0020534 <br /> Make changes/corrections 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 OW0016876 New Owner ID <br /> Owner Name JIM CADEL <br /> Owner DBA CADELL EQUIPMENT SALES <br /> Owner Address 11265 S HARLAN RD <br /> LATHROP, CA 95330 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-456-0020 <br /> Mailing Address 11265 S HARLAN RD <br /> LATHROP, CA 95330 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0020534 10187621 <br /> Facility Name CADELL EQUIPMENT SALES <br /> Location 11265 S HARLAN RD <br /> LATHROP, CA 95330 <br /> Phone 209-456-0020 x0 <br /> Mailing Address 11265 S HARLAN RD <br /> LATHROP, CA 95330 <br /> Care of <br /> Location Code 07 - LATHROP Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 19602007 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 AR0036738 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name JIM CADEL (Circle 0") <br /> Account Balance as of 11/1/2016: $0.00 <br /> (circle Onst <br /> Transfer to Active/Inactue <br /> Program/Element and Description Record ID Employee ID and Name Status New OvmeR Delete <br /> 1921 -HMBP-Regular-Primary Location PR0535610 EE0000010-PETER LOMBARDI Active Y N A lzzb D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO535975 Inactivc 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 specific.PMSIEHO hourly charges associated with this facility or: <br /> be bills l 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 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 /> EHD Staff: Date 1�1�1�� Account out: Z`Z Date�1/tel <br /> COMMENTS: <br /> y,�7 l Invoice#: <br /> zzt L f .� ��QaQ 2 2i 1 <br />