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Date nm 9/20/2013 2:41:06PR SAN JCv IUIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by �/ Pagel <br /> Facility Information as of 9/20/2013 <br /> Record Selection Criteria: Facility ID FA0019958 <br /> Make changealcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0016381 New Owner ID <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 lD/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 All Phone <br /> BOS District 002- RLIHSTALLER, LARRY Fax <br /> APN 07748012 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 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 9/20/2013: $271.00 <br /> (Circle One) <br /> Transfer to Actnednact,e <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> (IgnHMBP-Common Materials PR0530802 EE0006044-LOWELL ALLEN Active Y N A 0 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 that all site,and/or project specific,PHSIEHO 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: Date / I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date I / <br /> Payment Type Check Number Recei <br /> REHS: ?- — Date / /J Account out: Date <br /> COMMENTS: <br /> dpu1411 r—r 7—,tZ c9 C <br /> C/;rH/ Cr4' t.� <br /> (zU12 � f <br />