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Report 45021 <br /> Date ran 10/192017 3:38:19P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Paget <br /> Run by Facility Information as of 10/19/2017 <br /> Record Selection Criteria: Facility ID FA0018133 <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 OW0014876 New Owner ID <br /> Owner Name JACKEY WONG &AMBROSE TAM <br /> Owner DBA WARDLEY FILM <br /> Owner Address 907 N STOKES AVE <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-932-1088 <br /> Mailing Address PO BOX 55323 <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> FacilityID/CERS ID FA0018133 10589497 <br /> Facility Name WARDLEY INDUSTRIAL INC. <br /> Location—Q9 T-O"venue P <br /> STOCKTON, CA 95215 <br /> Phone 209-932-1088 x <br /> Mailing Address PO BOX 55323 <br /> STOCKTON, CA 95205 <br /> Care of WARDLEY INDUSTRIAL INC. <br /> Location Code Alt Phone <br /> BOS District 002-MILLER, KATHERINE Fax <br /> APN 143-280-520-00( Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0031903 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name MARGARET WONG (Circle one) <br /> Account Balance as of 10/19/2017: $0.00 <br /> (Circle One) <br /> Transfer to Activennache <br /> Program/Element and Description Record ID Employee ID and Name status New Owner? Oelete <br /> 1921 -HMBP-Reqular-Primary Location PR0526776 EE0008709-JAMIE LIMA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO53859M EE0000031 -ELIANNA FLORIDO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0534762 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge Nat all site,andor project specific.PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party ident@ied as Ne OWNER on this form. I also certify that all operations will be performed m accordance with all applicable Ordinance Codes andor Standards and State ander <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 Typie N Check Number Received by ,J <br /> EHDStaff: I'kil � Date / / Accountout: Date / /— <br /> COMMENTS: <br /> Invoice#: <br />