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Date run 7/21/2017 2:32:38PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/21/2017 <br /> Record Selection Criteria: Facility ID FA0015869 <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/Fed Tax ID <br /> Owner ID OW0012790 New Owner ID <br /> Owner Name ,James Bahr <br /> Owner DBA MARINE SALVAGE <br /> Owner Address 3832 S HWY 99 <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-466-9283 <br /> Mailing Address 3832 S Hwy 99 <br /> Stockton, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0015869 10185031 <br /> Facility Name MARINE SALVAGE <br /> Location 3832 S HWY 99 <br /> STOCKTON, CA 95215 <br /> Phone 204-669-283 x <br /> Mailing Address 3832 S Hwy 99 <br /> Stockton, CA 95215 <br /> Care of ,James Bahr <br /> Location Code Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 17917133 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027625 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Marine Engine (CirmeOne) <br /> Account Balance as of 7/21/2017: $0.00 <br /> (Circe One) <br /> Transfer to Activellnal <br /> Program/Element and Description Record ID Employee In and Name Status New Owner �/Delete <br /> 1921 -HMBP-Regular-Primary Location PRO623490 EE0008709-JAMIE LIMA Active Y N A i D <br /> 2220-SM HW GEN<5 TONS/YR PRO538049 EE0000031 -ELIANNA FLORIDO Active Y N A P D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0533883 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT'. I,the undersigned owner,operator or agent of same,acknowledge that all site,andior project specific,PHSEHD 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 andior Standards and State angor <br /> Federal Laws. <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 T e, Check Number Received y '1 <br /> EHD Staff: t �A._- Date�/ /1Z Account out: Date�/ /I <br /> COMMENTS'. <br /> Miria Jrtp 10ir f-r- k4 rep6riotp � of Invoice#: <br /> UAC 011, 4)Gempt flim � gyp. <br />