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Date mn 2/24/2017 8:30:59AR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Run by Report#5021 <br /> Facility Information as of 2/24/2017 Pagel <br /> Record Selection union, Facility ID FA0003591 <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 <br /> SSN/Fed Tax ID <br /> Owner ID OW0011842 New Owner ID <br /> Owner Name JAMES MICHAEL &ASSOCIATES <br /> Owner DBA <br /> Owner-Address 4111 CLARINBRIDGE CIR <br /> DUBLILN, CA 94568 <br /> Home Phone 925-803-5026 Sl o�kEa r n 9 t 9 <br /> Work(Business Phone Not Specified <br /> Mailing Address 1630 N MAIN ST#320 <br /> WALNUT CREEK, CA 94596-4609 <br /> Care of JAMES HARRINGTON/CONRAD COLBRANI <br /> FACILITY FILE INFORMATION Site Miti ation Facility <br /> Facility ID/CERS ID FA0003591 10181225 <br /> Facility Name JAMES MICHAEL&ASSOC <br /> Location 8203 E HWY 26 <br /> STOCKTON, CA 952159536 <br /> Phone 925-803-5026 <br /> Mailing Address 4111 CLARINBRIDGE CIR <br /> DUBLIN, CA 94568 <br /> Care of JAMES HARRINGTON/CONRAD COLBRANE <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 002- MILLER, KATHERINE Fax <br /> APN 10114021 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name AMARJIT SINGH <br /> Title ry7J <br /> Day Phone 209-931-5487 J('J <br /> Night Phone 209-474-6708 1J( <br /> ACCOUNTS RECEIVABLE 6017: $10,971.00 <br /> N <br /> Account ID ,(�� New Account ID: <br /> Mail Invoices to ` Mail Invoices to: Owner / Facility / Account <br /> Account NameL& S OCIATES (Circle One) <br /> Account Balance as of 2/2 .00 (Cim1e One) <br /> Transferto ActivelinaMe <br /> Program/ElementCintl DescriptionRecord ID Employee ID antl Name Status New Owne(t Delete <br /> 1615-RETAIL MKT 301-2000 SD PF PRO524324 EE0009488-JEFFREY WONG Inactiv( Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO512147 EE0008709-JAMIE LIMA Inactivc Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO522765 EE0000031 -ELIANNA FLORIDO Active ( N A I D <br /> 2361-UST FACILITY PR0231595 EE0000031 -ELIANNA FLORIDO Activel)C-'9p�'S N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO507356 EE0000008-LETITIA BRIGGS Inactive N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532410 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,me undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSEHD 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 wth all applicable Ordinance Codes and/or standards and state and/or <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 —7 <br /> EHD Staff: e i Date / / Account out: Date <br /> COMMENTS: <br /> 4 Invoice#: <br /> � �1� <br />