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Date run 12/28/2017 9:15:31A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by M OZUNA Facility Information as of 12/28/2017 Pagel <br /> Record Selection Criteria: Facility ID FA0010940 <br /> Make changestcorrections 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 OW0008940 Case Number: H09019 New Owner ID : <br /> Owner Name BONILLA, JUAN GILBERTO <br /> Owner DBA ALMAZAN WELDING SERVICES <br /> Owner Address 1691 LEVER BLVD <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-464-2336 <br /> Mailing Address 1691 LEVER BLVD <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010940 10183953 <br /> Facility Name ALMAZAN WELDING SERVICES <br /> Location 1566 S STOCKTON ST <br /> STOCKTON, CA 95206 <br /> Phone 209-464-2336 x0 1 <br /> Mailing Address 169 D S. S+oe- .S f <br /> STO N, 206 GA 9SJ 0!0 <br /> Care of ilia Gilberto <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 16323028 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Juan Bonilla <br /> Title <br /> Day Phone 209-942-4280 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017940 New Account I P-�. <br /> Mail Invoices to Account Mail Invoices to: I wne / Facility / Dcount <br /> Account Name ALMAZAN WELDING SERVICES ir`lllooe <br /> Account Balance as of 12/28/2017: $559.40 <br /> (Circe One) <br /> Transferto Active/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520563 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513228 EE0000000-HAZ MAT SJC DES Inactive Y N A 1 D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510940 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531723 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific,PHSfEHD 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 anclor Standards and Slate and'or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: A-GCi"'" Date —12- <br /> Program Records to be TRA ERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Receiveq by ,�J <br /> EHD Staff: Date /_/ Account out: Date <br /> COMMENTS: Invoice#: <br />