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Date run 2/26/2014 8:39:55AA SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT <br /> Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/26/2014 <br /> Record selection Criteria: Facility ID FA0015891 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN1 Fed Tax ID <br /> Owner ID OW0012812 New Owner ID <br /> Owner Name ROBERT SCHROEDER <br /> Owner DBA STANLEY-ADAMS MACHINE <br /> Owner Address 1510 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-466-2355 <br /> Mailing Address 1510 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0015891 10,185,057 <br /> Facility Name STANLEY ADAMS MACHINE <br /> Location 1510 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-466-2355 x0 <br /> Mailing Address 1510 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 001 -VILLAPIIDUA Fax <br /> APN 15303001 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 AR0027647 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name ROBERT SCHROEDER (Circle One) <br /> Account Balance as of 2/26/2014-. $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0523512 EE0006044-LOWELL ALLEN Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532389 Inactive Y N A I D <br /> BULLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andbr project specific,PHSIEHD 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 and'or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 ! <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date ! ! <br /> Water System to be TRANSFERED: Amount Paid Date f ! <br /> Payment Type Check Number Received by <br /> RENS: Date 1 1 Account out: Date 1 ! <br /> COMMENTS: <br />