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Date run 9/4/2015 8:30:25AM SAN JOIN COUNTY ENVIRONMENTAL HEALfPEPARTMENT Report x5021 Run by Pagel Facility Information as of 9/4/2015 Record Selection Criteria: Facility ID FA0011044 Make changes/corrections in RED ink. INFORMATION CHANGE(date) OWNERSHIP CHANGE(date) OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID Owner ID OW0009044 Case Number: H09208 New Owner ID Owner Name LOWELLBEGHTEL Owner DBA STOCKTON FENCE & MATERIAL CO Owner Address 2007 N WILSON WAY STOCKTON, CA 95205 Home Phone Not Specified WorWBusiness Phone 209-466-3166 Mailing Address PO BOX 8314 STOCKTON, CA 95208-0314 Care of FACILITY FILE INFORMATION Facility ID/CERS ID FA0011044 10184057 Facility Name STOCKTON FENCE & MATERIAL CO Location 2007 WILSON WAY STOCKTON, CA 95205 Phone 209-466-3166 x0 Mailing Address PO BOX 8314 STOCKTON, CA 95208-0314 Care of Lowell Beghtel Location Code Alt Phone BOS District Fax APN 11715030 EMail: EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0018044 New Account ID: Mail Invoices to Account Mail Invoices to: Owner / Facility / Account Account Name STOCKTON FENCE & MATERIAL CO (Circle One) Account Balance as of 9/4/2015: $0.00 (Circle One) Transferto Active/Inachm PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delele 1921 -HMBP-Regular-Primary Location PR0520629 EE0000006-HAZA SAEED Active Y N A I D 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513332 EE0000000-HAZ MAT SJC OES Inactive Y N A I D 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0511044 EE0000000-HAZ MAT SJC DES Inactive Y N A I D ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534780 Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and'or project specific,PHSrEHD hourly Merges associated with this facility 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 andlor Standards and State ani Federal Laws. APPLICANTS SIGNATURE: Date / / Program Records to be TRANSFERED: •$25.00= Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received by EHD Staff: Date / / Account out: Date / / COMMENTS: Invoice#: