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Date mn 12/28/2017 2:21:54P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/28/2017 <br /> Record Selection Criteria: Facility ID FA0019059 <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 OW0015685 New Owner ID <br /> Owner Name CAL FIRE <br /> Owner DBA <br /> OwnerAddress 16502 SCHULTE RD <br /> TRACY, CA 953779700 <br /> Home Phone 209-835-8833 <br /> Work/Business Phone 916-376-5000 <br /> Mailing Address P.O. BOX 944246 <br /> SACRAMNETO, CA 94244 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0019059 10398139 <br /> Facility Name CAL FIRE- CASTLE ROCK FFS <br /> Location 16502 W Schulte Rd <br /> Tracy, CA 95377 <br /> Phone 209-835-8853 x <br /> Mailing Address 16502 W. Schulte Road <br /> Tracy, CA 95376 <br /> Care of SCU-Castle Rock#26 <br /> Location Code 99-UNINCORPORATED A Alt Phone <br /> BOIS District 005- ELLIOTT, BOB Fax <br /> APN 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 AR0033918 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Sarah Olals (Circle One) <br /> Account Balance as of 12/28/2017: $0.00 <br /> (Cimle One) <br /> Transfer to Activellnal <br /> Program/Element and Description Record ID Employee ID and Name Status New OysteR Delete <br /> 2840-AST EXEMPT FAC 11,320 GAL PR0528154 EE0002646-THUYTRAN Inactl7f Y IN A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project speck,PHS/EHD hourly charges associated with this facility <br /> or activity will Be billed to the party identified as the OWNER on this fano. I also certify that all operations will he performed in accordance with all applicable Ordinance Codes ani Standards and State al <br /> Federal Laws. <br /> APPLICANTS 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 />