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Date run 8/17/2015 1:25:08PR SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report 95021 <br /> Run try Pagel <br /> Facility Information as of 8/17/2015 <br /> Record Selection Criteria: Facility ID FA0011206 <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 OW0009206 Case Number: H09453 New Owner ID <br /> Owner Name EMPLOYEE OWNED CORP <br /> Owner DBA BIG VALLEY AVIATION INC <br /> Owner Address 7835 S LINDBERGH ST <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-982_4991 <br /> Mailing Address 7535 S LINDBERGH ST <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0011206 10184103 <br /> Facility Name BIG VALLEY AVIATION INC <br /> Location 7,535 S LINDBERGH ST <br /> STOCKTON, CA 95206 <br /> Phone 209-982-4991 x <br /> Mailing Address 7535 S LINDBERGH ST <br /> STOCKTON, CA 95206 <br /> Care of Paul McKenzie <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 17726034 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 AR0018206 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility f Account <br /> Account Name BIG VALLEY AVIATION INC (Circle One) <br /> Account Balance as of 811712015: $0.00 <br /> (Circle One) <br /> Transfer to Activellnaclve <br /> ProgramlElementcnd Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520750 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONSIYR PR0517858 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513494 EE0000000-HAZ MAT SJC OES InaCtIVE Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0511206 EE0000000-HAZ MAT SJC OES InactivE Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531356 Inactiv( 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,PHSIFHD 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 and/or Standards and State andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 I <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date I I <br /> Payment Type Check Number Received by <br /> EHD Staff: Date ! f Account out: Date ! ! <br /> COMMENTS: <br /> Invoice#: <br />