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'Date nm - 12/24/2014 11:03:39/ <br /> SAN JCOUIN COUNTY ENVIRONMENTAL HEA.I DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12124/2014 <br /> Record Selection Criteria: Facility ID FA0018762 <br /> Make changes/corrections 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 OW0015429 New Owner ID <br /> Owner Name LARRYMETHVIN <br /> Owner DBA ALL COUNTIES GLASS <br /> Owner Address 2020 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-888-8720 <br /> Mailing Address 501 KETTERING DR <br /> ONTARIO, CA 91761 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0018762 10186985 <br /> Facility Name ALL COUNTIES GLASS <br /> Location 2020 MINER AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-888-8720 x0 <br /> Mailing Address 2020 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 15312001 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 AR0033307 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name LARRY METHVIN (Circle One) <br /> Account Balance as of 12/24/2014: $0.00 <br /> (Circe One) <br /> Transferto Active/Inadve <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner'! Delete <br /> 1921 -HMBP-Regular-Primary Location PR0527678 EE0000006-HAZA SAEED Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533679 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the parry identified as the OWNER on this to= l also certify that all operations will be performed in accordance with all applicable Ordinance Codes andtor Standards and State andor <br /> Federal Lawn. <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 Received by <br /> REHS: Date / /_ Account out: Date <br /> COMMENTS: <br />