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Date run 12/18/2014 16:34:17/ Report x5021 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Pagel <br /> Ranby Facility Information as of 12/18/2014 <br /> Record Selection Cinema: Facility ID FA0017348 <br /> Make changeslcorrections 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 OW0014189 New Owner ID <br /> Owner Name MARTIN SCHULER <br /> Owner DBA MARTIN SCHULER <br /> Owner Address 23594 E HWY 120 <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 487 <br /> ESCALON, CA 95320 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017348 10186305 <br /> Facility Name MARTIN SCHULER <br /> Location 23594 E HWY 120 <br /> ESCALON, CA 95320 <br /> Phone 209-838-2622 x0 <br /> Mailing Address PO BOX 487 <br /> ESCALON, CA 95320 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 24702007 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 AR0030230 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name MARTIN SCHULER (Circle One) <br /> Account Balance as of 12/18/2014: $0.00 <br /> (Circle One) <br /> Transferto Active/InacNe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525533 EE0002474-MICHAEL PARISSI Active Y N A 1 D <br /> 2640-AST EXEMPT FAC <1,320 GAL PRO529609 EE0000753-WILLY NG Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO536698 EE0009000-HARPRIT MATTU Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531527 InactivE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander protect 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 Ialso canny that all operations will be performed in accordance with all applicable Ordinance Codes ander Standard.and State andor <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 Type Check Number Received by <br /> REHS: Date / /_ Account out: Date <br /> COMMENTS <br />