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Date run 3/23/2016 4:06:28PIv SAN JOIN COUNTY ENVIRONMENTAL HEAL#EPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/23/2016 <br /> Record Selection Criteria: Facility ID FA0003798 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN/Fed Tax ID <br /> Owner ID OW0005883 New Owner ID <br /> Owner Name EPPLER, DARRELL <br /> Owner DBA MARCH LN 76#255886 <br /> Owner Address 50764 RD 220 <br /> OAKHURST, CA 93644 <br /> Home Phone Not Specified <br /> Work/Business Phone 559-760-1950 <br /> Mailing Address 2701 W MARCH LN <br /> STOCKTON, CA 95219 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FAD003798 10181433 <br /> Facility Name MARCH LANE 76* <br /> Location 2701 W MARCH LN <br /> STOCKTON, CA 95219 <br /> Phone 209-473-7337 x <br /> Mailing Address 2701 W MARCH LN <br /> STOCKTON, CA 95219 <br /> Care of EPPLER, DARRELL <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOIS District 002- MILLER, KATHERINE Fax <br /> APN 11619007 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 AR0003382 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name MARCH LANE 76* (Circle One) <br /> Account Balance as of 3/23/2016: $0.00 <br /> (Circle One) <br /> Program/Element and Description Record ID Em to ee ID antl Name Transferto ActiveAnaclve <br /> Employee Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520496 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO517579 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513093 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PRO515550 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 2361 -UST FACILITY PR0231176 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0507473 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0531995 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned owner,operator or agent ofsame,acknowledge that all site,andror project specific,PHSIEHD hourly charges associated with this facility or[ <br /> be billed to the party identRed as the OWNER on this forth. I also certify that all operations will be performed in accordance w1h all applicable Ordinance Codes andfor Standards and State andror 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 / / Account out: Date <br /> COMMENTS: <br /> Invoice A <br />