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Date run 8/24/2018 3:31:12PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 8/24/2018 <br />Record Selection Criteria: Facility ID FA0023434 <br />OWNER FILE INFORMATION Number of facilities for this owner : 1 <br />Owner ID <br />OW0021671 <br />Owner Name <br />BONADONNA, DAVID <br />Owner DBA <br />3927 S EL DORADO ST <br />OwnerAddress <br />3927 S ELDORADO ST <br />Phone <br />STOCKTON, CA 95206 <br />Home Phone <br />209-982-1804 <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />PO BOX 6377 <br />Location Code <br />STOCKTON, CA 95206 <br />Care of <br />001 - VILLAPUDUA, CARLOS Fax <br />FACILITY FILE INFORMATION <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Facility ID / CERS ID <br />FA0023434 <br />Facility Name <br />BONADONNAS ASPHALT REPAIR <br />Location <br />3927 S EL DORADO ST <br />STOCKTON, CA 95206 <br />Phone <br />209-982-1804 <br />Mailing Address <br />PO BOX 6377 <br />STOCKTON, CA 95206 <br />Care of <br />Location Code <br />01-STOCKTON Alt Phone <br />BOS District <br />001 - VILLAPUDUA, CARLOS Fax <br />APN <br />17525055 EMail: <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />BONADON NA, DAVID <br />Title <br />Day Phone <br />209-982-1804 <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID <br />AR0043199 NewAccount ID: <br />Mail Invoices to <br />Account Mail Invoices to: Owner / Facility / Account <br />Account Name <br />BONADONNAS ASPHALT REPAIR (Circle One) <br />Account Balance as of 8/24/2018: $979.70 <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 PRO540994 EE0009817 - ROBERT LOPEZ Active Y N A I D <br />2220 - SM HW GEN <5 TONS/YR PR0540949 EE0000026 - CESAR RUVALCABA Active Y N A D <br />2831 -AST FAC >/= 1,320 - <10 K GAL CUMULATIVE PR0540950 EE0000026 - CESAR RUVALCABA 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. 1 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 />Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Type Check Number Received by <br />EHD Staff: 16':? Date'/ L/ 2 Account out: Date <br />COMMENTS: <br />Invoice #: <br />