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Date run 12/28/2017 1:49:09F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 12/2812017 <br /> Record Selection Criteria: Facility ID FA0015473 <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 1 Fed Tax ID _ <br /> Owner ID OW0012426 New Owner ID <br /> Owner Name CRAIG EDWARDS _ <br /> Owner DBA ACAMPO MACHINE WORKS <br /> OwnerAddress 930 S SACRAMENTO ST <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-329-6680 <br /> Mailing Address 930 S SACRAMENTO ST <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0015473 10184941 <br /> Facility Name ACAMPO MACHINE WORKS <br /> Location 930 S SACRAMENTO ST <br /> LODI, CA 95240 <br /> Phone 209-334-6638 x0 <br /> Mailing Address 930 S SACRAMENTO ST <br /> LODI, CA 95240 <br /> Care of Craig Edwards <br /> Location Code Alt Phone <br /> BOS District 004-WINN, CHARLES Fax <br /> APN 04526005 1 Mail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026715 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name ACAMPO MACHINE WORKS (Circle One) <br /> Account Balance as of 1212812017:. $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0522702 EE0008709-JAMIE LIMA Active Y N A I D <br /> 2221 -USED OIL ONLY-<5 TONSIYR PR0538489 EE9999998-ONE VACANTI Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO534390 Iii Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that ali site,ardlor project specific.PHSIEHD 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 andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date 1 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 1 <br /> COMMENTS: Invoice#: <br />