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Date run 11/2712017 1:33:46P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/27/2017 <br /> Record Selection Criteria: Facility ID FA0010318 <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 I Fed Tax ID <br /> Owner ID OW0008318 Case Number: H07729 New Owner ID <br /> Owner Name ROSEMARY GAMBLIN <br /> Owner DBA ALPHA ENTERPRISE CORP <br /> OwnerAddress 23 MAXWELL ST <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209334-2464 <br /> Mailing Address 23 MAXWELL ST <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010318 10183439 <br /> Facility Name ALPHA ENTERPRISE CORP <br /> Location 23 Maxwell St <br /> Lodi, CA 95240 <br /> Phone 209_334-2464 x <br /> Mailing Address 23 MAXWELL ST <br /> LODI, CA 95240 <br /> Care of K Douglas Gamblin <br /> Location Code 02 - LODI Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 06205004 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 AR0017318 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner I Facility I Account <br /> Account Name ALPHA ENTERPRISE CORP (Circle one) <br /> Account Balance as of 1112712017: $0.00 <br /> (Circle One) <br /> Transfer to Activellnectve <br /> PragramfElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBR Regular-Primary Location PR0520228 EE0008709-JAMIE LIMA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514282 EE9999998-ONE VACANT1 Active Y N A I D <br /> 2224-I MAT BUSINESS PLAN AUTHORIZATION PRO512606 EE0000o00-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE Fi PR0510318 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532324 Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project speck,PHSTEHD 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 andror Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 ! <br /> Payment Type Check Number Received by <br /> El Staff: Date ! 1 Account out: _ Date 1 ! <br /> COMMENTS: Invoice#: <br />