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Date run 41/9/2017 2:41:28PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 11/9/2017 <br />Record Selection Criteria: Facility ID FA0023518 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0021798 <br />Owner Name <br />Lennox Industries Inc. <br />Owner DBA <br />Owner Address <br />2100 LAKE PARK BLVD <br />RICHARDSON, TX 75080 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />972-497-5000 <br />Mailing Address <br />2100 Lake Park Boulevard <br />Richardson, TX 75080 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0023518 10664083 <br />Facility Name <br />LENNOX PARTS PLUS A534 <br />Location <br />2750 CHEROKEE RD STE 4 <br />STOCKTON, CA 95205 <br />Phone <br />209-235-1600 x <br />Mailing Address <br />2750 Cherokee Rd Ste 4 <br />Stockton, CA 95205 <br />Care of <br />Lennox Parts Plus A534 <br />Location Code <br />01 - STOCKTON <br />BOS District <br />002 - MILLER, KATHERINE <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0043369 <br />Mail Invoices to Account <br />Account Name Richard Mosher III <br />Account Balance as of 11/9/2017: $404.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />1 SSN/Fed Tax ID <br />New Owner ID : <br />C> L r- lL v <br />r C> x 0 0— S `f <br />Alt Phone <br />Fax <br />EMail : <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1921 - HMBP-Reqular-Primary Location PR0541078 EE0009817 - ROBERT LOPEZ Active Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD 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 with all applicable Ordinance Codes 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 />" $25.00 = <br />Date <br />Date <br />Amount Paid Date -/-/ <br />_ Amount Paid Date <br />Received by <br />Account out: Date <br />Invoice #: <br />