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Date run 6/5/2017 10:31:39AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Reports l <br /> Run by <br /> Facility Information as of 6/5/2017 Pagel <br /> Recom Selection Criteria: Facility ID FA0022800 <br /> Make changesicorrections 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 OW0020687 New Owner ID <br /> Owner Name Gary Alegre <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-932-0495 <br /> Mailing Address 743 W Anderson St. <br /> Stockton, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0022800 10619341 <br /> Facility Name Blue Mountain Minerals <br /> Location 1001 HUMPHREYS DR <br /> Stockton, CA 95203 <br /> Phone 209-932-0495 x <br /> Mailing Address 743 W Anderson St. <br /> Stockton, CA 95206 <br /> Care of Michael Vilarino <br /> Location Code Alt Phone <br /> SOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Michael Vilarino <br /> Title General Manager <br /> Day Phone 209-932-0495 <br /> Night Phone 209-649-8651 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0041814 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Michael Vilarino (Circle One) <br /> Account Balance as of 6/5/2017: $0.00 <br /> (Circle One) <br /> Transfer to Activ nactve <br /> Program/Element and Description Record ID Employee ID and Name Status New OwneO Delete <br /> 1921 -HMBP-Regular-Primary Location PR0539856 EE0009817-ROBERT LOPEZ Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PR0539855 EE0001421 -STACY RIVERA Active Y N A D <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PRO539858 EE0001421 -STACY RIVERA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andt"project specni PHSAEHD hourly charges associated with this facility <br /> or activity will be billed to the party ideraifed as the OWNER on this form. I also certify that all operations will be pedomed in accordance with all applicable Ordinance Codes andor Standards and State ander <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 e Received by <br /> EHD Staff: Date / / � Account out 14 Date <br /> COMMENTS: -_ �T /nZ+v'+�L <br /> I� L.�¢-2 N�"` I'..'ysec-q� 614-/. j Invoice#: <br /> o o <br /> rry APSA gbov� �3Za �y�ll�-s . ��.. ZTzd <br /> F('ac ��"y C~IAA ms bus•reSS i 5 Jia �r7n5 er vpc✓J,r zg32 <br /> AS �f earltga� y 1 OAD 1 CHO-\ <br /> > s5 �lkpo , g <br />