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Date run 3/9/2016 4:17:30PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 3/9/2016 <br />Record Selection Criteria: Facility ID FA0021430 <br />OWNER FILE INFORMATION Number of facilities for this owner: <br />Owner ID OW0017623 <br />Owner Name WEST VALLEY CONSTRUCTION <br />Owner DBA WEST VALLEY CONSTRUCTION <br />Owner Address 580 MCGLINCY LN <br />CAMPBELL, CA 95008 <br />Home Phone 408-371-5510 <br />Work/Business Phone 408-371-5510 <br />Mailing Address 580 MCGLINCY LN <br />CAMPBELL, CA 95008 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0021430 10187903 <br />Facility Name WEST VALLEY CONSTRUCTION <br />Location 2655 E MINER AVE <br />STOCKTON, CA 95205 <br />Phone 209-943-6812 x <br />Mailing Address 580 MCGLINCY LN <br />CAMPBELL, CA 95008 <br />Care of West Valley Construction <br />Location Code 01 - STOCKTON <br />Bos District 001 - VILLAPUDUA, CARLOS <br />APN 14343023 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN /Fed Tax ID <br />New Owner ID <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0038795 <br />New Account ID: <br />Mail Invoices to Account Mail Invoices to: <br />Owner / <br />Account Name WEST VALLEY CONSTRUCTION <br />Account Balance as of 3/9/2016: $0.00 <br />Program/Element and Description Record ID Employee ID and Name <br />Status <br />1921 - HMBP-Regular-Primary Location PRO537314 EE0000006 - HAZA SAEED <br />Active <br />2220 - SM HW GEN <5 TONS/YR PR0539816 EE0000027 - CINDY VO <br />Active <br />Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />New Owner? Delete <br />Y N A I D <br />Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD 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 and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: * $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Type /. b Check Number Received b <br />EHD Staff: U Date / / Account out: Date c3 /K/ / <br />COMMENTS: <br />'�-- 7 1 , f-,/ I � - Ft, e-, * <br />Aqs ks v�hn-. uw&f- ZbSS <br />smwn <br />nvolce <br />E - Arq�-Ale' 0 Ackk <br />-0.41 kt3e2ST <br />