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Date run 6/23/2016 3:01:23PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 6/23/2016 <br />Record Selection Criteria: Facility ID FA0017515 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID OW0014356 <br />Owner Name <br />STEPHEN M ALEGRE <br />Owner DBA <br />STEPHEN M ALEGRE <br />OwnerAddress <br />21763 S LAMMERS RD <br />Owner / <br />TRACY, CA 95304 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />21763 S LAMMERS RD <br />Care of <br />TRACY, CA 95304 <br />Care of <br />99 - UNINCORPORATED A <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0017515 10186571 <br />Facility Name <br />STEPHEN M ALEGRE <br />Location <br />24915 HANSEN RD <br />Owner / <br />TRACY, CA 95304 <br />Phone <br />209-321-6819 x0 <br />Mailing Address <br />21763 S LAMMERS RD <br />Account Balance as of 6/23/2016: $1,956.00 <br />TRACY, CA 95304 <br />Care of <br />Location Code <br />99 - UNINCORPORATED A <br />Bos District <br />005 - ELLIOTT, BOB <br />APN <br />20912005 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name STEPHEN M ALEGRE <br />Title OWNER <br />Day Phone 209-321-6819 <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) - Z3 <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0030397 <br />NewAccount ID: <br />: <br />Mail Invoices to Owner <br />Mail Invoices to: <br />Owner / <br />Facility / Account <br />Account Name STEPHEN M ALEGRE <br />(Circle One) <br />Account Balance as of 6/23/2016: $1,956.00 <br />(Circle One) <br />Transfer to Active/lnactve <br />Program/Element and Description Record ID <br />Employee ID and Name <br />Status <br />New Owner? Delete <br />1958 - HM -Farm Operations PR0525700 <br />EE0002670 - MUNIAPPA NAIDU <br />Active <br />Y N A � D <br />2220 - SM HW GEN <5 TONS/YR PR0536104 <br />EE0001459 -VICKI MCCARTNEY <br />Active <br />Y N A D <br />2830 -AST FAC - SPCC EXEMPT PR0530993 <br />EE0001459 - VICKI MCCARTNEY <br />Inactive <br />Y N A I D <br />4740 - WASTE TIRE SITE - EXEMPT PRO536097 <br />EE0002622 - BENJAMIN ESCOTTO <br />Active <br />Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI PR0532394 <br />Inactive <br />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 andror <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: " $25.00 = <br />Amount Paid Date <br />Water System to be TRANSFERED: <br />Amount Paid Date <br />Payment Type Check Number <br />Received by <br />EHD Staff: 4 G - Date — Account out: <br />Date <br />COMMENTS: r� ` <br />Invoice #: <br />