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Date run 4/8/2015 2:36:27PM SAN JOi�JIN COUNTY ENVIRONMENTAL HEAL�i DEPARTMENT Report#5021 <br /> Run by pal <br /> Facility Information as of 4/8/2015 <br /> Record Selection Criteria: Facility ID FA0022522 <br /> Make changesicorrections 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 OW0020050 New Owner ID <br /> Owner Name Frank D. Mills <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-631-1491 <br /> Mailing Address 4926 W Turner Rd <br /> Lodi, CA 95242 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0022522 10481851 <br /> Facility Name Turner Road Storage <br /> Location 4926 W Turner Rd <br /> Lodi, CA 95242 <br /> Phone 209-631-1491 x <br /> Mailing Address 4926 West Turner Road <br /> Lodi, CA 95242 <br /> Care of Frank D. Mills <br /> Location Code Alt Phone <br /> BOS District 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 AR0041202 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name Turner Road Storage (Circle one) <br /> Account Balance as of 4/8/2015: $0.00 <br /> (Circle One) <br /> Transfer to Acfivwlname <br /> Prograym�/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> iL1Sat OAW4 agWar-Primary Location PR0539405 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> BILLINGand COMPLIANCE ACKNOWLEDGEMENT 1,the 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 cenify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State angor <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((TT��ttvvp,,q ,� Check Number Recely y _ <br /> REHS: �/� NAS <br /> I 1/^,D,ry`Date}n ',/ / A/cy�count/o�u/t:1 OLS <br /> �sD/ate <br /> COMMENTS Not a NAS jNZ I l ' • M CKM VOn OL p6 <br />