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Date run 12/8/2017 4:53:OOPA SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/8/2017 <br /> Record Selection Criteria: Facility ID FA0013801 <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: 2 SSNI Fed Tax ID <br /> Owner ID OW0009598 New Owner ID <br /> Owner Name NEAL, ERICA <br /> Owner DBA LODI TRUCK CENTER <br /> Owner Address 19681 N HIGHWAY 99 <br /> ACAMPO, CA 952209799 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-327-9575 <br /> Mailing Address 19681 N HWY 99 <br /> ACAMPO, CA 95220 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0013801 10184527 <br /> Facility Name LODI RV CENTER <br /> Location 19681 N HWY 99 <br /> ACAMPO, CA 95220-9799 <br /> Phone 209-369-1431 x <br /> Mailing Address 19681 N HWY 99 A n 1 <br /> ACAMPO, CA 95220 <br /> Care of Eric Neal <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOB District 004-WINN, CHARLES Fax <br /> APN 01321051 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 AR0023203 //'' New Account ID: <br /> Mail Invoices to Account I A, Mail Invoices to: Owner / Facility / Account <br /> Account Name LODI RVCEN / V (Circle One) <br /> Account Balance as of 12/8/2017: 00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Progra"Element and Descnpuon Re rd ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PRO521176 EE0009817-ROBERT LOPEZ Active Y N A V D <br /> 2220-SM HW GEN<5 TONSNR PRO528498 EE0000030-AARON HANG Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO518272 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO518273 EE00o0000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528457 EE0000030-AARON HANG Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0524446 EE5555555-Garrett Alias-Backus Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532848 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor protect specific,PRSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identried 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 Stale andfor <br /> 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: tM - ►4ft{9'V Date Z- / /1' Account out: Date /Z-/ /.2— / 7 <br /> COMMENTS: <br /> Invoice#: <br />