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Date run 12112/2017 9:55:14,4 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12112/2017 <br /> Record Selection Criteria: Facility 9 D FA0024386 <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 1 Fed Tax ID <br /> Owner ID OW0022950 New Owner ID <br /> Owner Name IVAN AND ADELE CERRI <br /> Owner DBA VINTAGE PETROLEUM <br /> OwnerAddress 3415 MORNINGSIDE DR <br /> STOCKTON, CA 95219 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 3415 MORNINGSIDE DR <br /> STOCKTON, CA 95219 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0024386 <br /> Facility Name VINTAGE PETROLEUM <br /> Location 9571 S ROBERTS RD <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 9571 S ROBERTS RD <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 19112004 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 AR0045439 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name VINTAGE PETROLEUM (Circle One) <br /> Account Balance as of 12/12/2017: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0542434 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,PHSIEHn hou+iy!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 /> APPLICANTS SIGNATURE: Date f 1 <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 <br /> Payment Type Check Number Received by <br /> EHD Staff: Date 1 1 Account out: Date ! 1 <br /> COMMENTS: Invoice' ; <br />