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Datert 11/5/2013 11:58:58/ SAN JOS IN COUNTY ENVIRONMENTAL HEAL' DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11115/20 <br /> Record Selection Criteria: Facility ID FA0019958 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner 10 OW0016381 New Owner to <br /> Owner Name FRANK ECKELMAN <br /> Owner DBA STOCKTON TOOL RENTAL <br /> Owner Address 7555 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 7555 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019958 10,187,467 <br /> Facility Name STOCKTON TOOL RENTAL <br /> Location 7555 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone 209-477-2887 x0 <br /> Mailing Address 7555 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 002 - RLIHSTALLER, LARRY Fax <br /> APN 07748012 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 AR0035537 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name FRANK ECKELMAN (Circle One) <br /> Account Balance as of 11/15/2013: $ Y0/0 <br /> (Circle One) <br /> / — — <br /> Transfer <br /> Omer? <br /> Activee <br /> Program/Element and Description Record I Employee ID and Name Status New OmwneY! Deletelete <br /> 1920-HMBP-Common Materials PRO530802 EE0006044-LOWELL ALLEN Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532791 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge Nat all site,andfor 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 anNor standards and State anNor <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 Re c y <br /> REHS: Date / / Account out: Date l <br /> COMMENTS: <br />