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Date run 12/19/2017 2:35:28P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 12/19/2017 Pagel <br /> Record Selection Criteria: Facility ID FA0019607 <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 OW0016073 New Owner ID <br /> Owner Name DEL RIO PARTNERS <br /> Owner DBA <br /> OwnerAddress 10749 W WOODBRIDGE RD <br /> LODI, CA 952429305 <br /> Home Phone 209-609-5452 <br /> Work/Business Phone 209-333-2459 <br /> Mailing Address 11292 NALPINE RD <br /> STOCKTON, CA 95212 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility. ID/CERSID FA0019607 10187283 <br /> Facility Name DEL RIO PARTNERS <br /> Location 13000 W WOODBRIDGE RD <br /> LODI, CA 95242-9305 <br /> Phone 209-609-5452 x <br /> Mailing Address 11292 NALPINE RD <br /> STOCKTON, CA 95212 <br /> Care of Del Rio Partners <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 01103013 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 AR0034904 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name DEL RIO PARTN RS (Circle One) <br /> Account Balance as of 12/19/2017: $0. <br /> '(('��//((t�� I (Circle One) <br /> Program/�le ( $Lscription ecom ID Employee ID and Name Status Transfer to Aclivdlnaclve <br /> New Owner? Delete <br /> I-HMBP-Regular-Primary Location PR0539323 EE0008709-JAMIE LIMA Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0529646 EE0000030-AARON HANG Inactive Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0529645 EE0000030-AARON HANG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO533845 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project speck,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OVMER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <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 Typle Check NumberReceived b <br /> EHD Staff: LA w� Date_a_/J_!I__/Jq_ Account out: Date /.Z.� .2-1 / /7 <br /> COMMENTS: (rye/� /1 ,I n �,( 1� (� <br /> UA l�c.ril TOP- H 1" � L�I 4U ' iz 3-�aW T ' `SS U a ��I'voice#: <br /> Y 6p a MY� . <br />