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Date run 12/8/2017 1:50:10PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 12/8/2017 <br /> Record Selection Criteria: Facility ID FA0009090 <br /> Make changes/corrections 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 OW0007090 Case Number: H01063 New Owner ID <br /> Owner Name SAN JOAQUIN SULPHUR CO INC <br /> Owner DBA SAN JOAQUIN SULPHUR CO INC <br /> OwnerAddress 720 N SACRAMENTO ST <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-368-6676 <br /> Mailing Address PO BOX 700 <br /> LODI, CA 95241 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009090 10182405 <br /> Facility Name SAN JOAQUIN SULPHUR CO INC <br /> Location 720 N SACRAMENTO ST <br /> LODI, CA 95240 <br /> Phone 209-368-6676 x0 <br /> Mailing Address PO BOX 700 <br /> LODI, CA 95241 <br /> care of Janet Chandler <br /> Location Code 02- LODI Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 04118008 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 AR0016090 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SAN JOAQUIN SULPHUR CO INC (CimleOne) <br /> Account Balance as of 12/8/2017: $0.00 <br /> (Circle One) <br /> Transfer to ActivelrecNe <br /> Program/Element and Description Record ID Employee ID and Name Status New OwneO Delete <br /> 1862-CaIARP PROGRAM 2 FACILITY PRO514523 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO519375 EE0008709-JAMIE LIMA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511378 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO509090 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0631855 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specDc,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this fonn. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andlor Standards and State andlor <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 Received by <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: Invoice#: <br />