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oaterunl 8/1/2016 4:09:06PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report #5021 <br />Run by DONNA Pagel <br />Facility Information as of 8/1/2016 <br />Record Selection Criteria: Facility ID FA0012100 <br />Account Balance as of 8/1/2016: $483.00 <br />Make changes/corrections in RED ink. <br />(Circle One) <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION <br />Number of facilities for this owner: 1 <br />SSN /Fed Tax ID <br />Owner ID <br />OW0009382 <br />New Owner ID <br />Owner Name <br />BOYD, JERRY <br />Active <br />Owner DBA <br />BOYD & BOYD INDUSTRIES <br />2220 - SM HW GEN <5 TONS/YR PRO515355 <br />Owner Address <br />3600 CHESTER AVE <br />Y N <br />A I D <br />BAKERSFIELD, CA 93301 <br />EE0007289 - ALISON YOUNGBLOOD <br />Home Phone <br />Not Specified <br />A I D <br />Work/Business Phone <br />661-631-8400 <br />hourly <br />Mailing Address <br />3600 CHESTER AVE <br />will be performed in accordance with all applicable Ordinance <br />Codes <br />BAKERSFIELD, CA 93301 <br />Federal Laws. <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0012100 <br />Facility Name <br />BOYD & BOYD INDUSTRIES <br />Location <br />4652 E WATERLOO RD <br />STOCKTON, CA 95215 <br />Phone <br />209-931-0120 <br />Mailing Address <br />rd c. C�Y cSS <br />BAKERSFIELD, CA 93301 <br />Care of <br />Location Code <br />Alt Phone <br />BOS District <br />Fax <br />APN <br />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 <br />AR0019363 <br />New Account ID: <br />Mail Invoices to <br />Facility <br />Mail Invoices to: Owner / Facility / Account <br />Account Name <br />BOYD & BOYD INDUSTRIES <br />(Circle One) <br />Account Balance as of 8/1/2016: $483.00 <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: <br />COMMENTS <br />Date <br />$25.00 = Amount Paid Date / ! <br />Amount Paid Date <br />Date <br />Received by <br />Account out: Date <br />Invoice #: g l 3(4P Z <br />(Circle One) <br />Transfer to <br />Active/Inactve <br />Program/Element and Description Record ID <br />Employee ID and Name <br />Status <br />New Owner? <br />Delete <br />1921 - HMBP-Regular-Primary Location PR0541118 <br />EE0000009 - NICHOLAS LOEHRER <br />Active <br />Y N <br />A I D <br />2220 - SM HW GEN <5 TONS/YR PRO515355 <br />EE0007289 - ALISON YOUNGBLOOD <br />Active <br />Y N <br />A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PR0516169 <br />EE0007289 - ALISON YOUNGBLOOD <br />Inactive <br />Y N <br />A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT I, the undersigned owner, operator or agent <br />of same, acknowledge that all site, andfor project specific, PHS/EHD <br />hourly <br />charges associated with this facility <br />of activity will be billed to the party identified as the OWNER on this form. I also certify that all operations <br />will be performed in accordance with all applicable Ordinance <br />Codes <br />and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: <br />COMMENTS <br />Date <br />$25.00 = Amount Paid Date / ! <br />Amount Paid Date <br />Date <br />Received by <br />Account out: Date <br />Invoice #: g l 3(4P Z <br />