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Dula mn 6/5/2017 10:31:39AM <br /> Run by SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report#5021 <br /> Facility Information as of 6/5/2017 Pagel <br /> Record Selection cause: Facility ID FA0022800 <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 OW0020687 New Owner ID <br /> Owner Name Gary Alegre <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-932-0495 <br /> Mailing Address 743 W Anderson St. <br /> Stockton, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0022800 10619341 <br /> Facility Name Blue Mountain Minerals <br /> Location 1001 HUMPHREYS DR <br /> Stockton, CA 95203 <br /> Phone 209-932-0495 x <br /> Mailing Address 743 W Anderson St. <br /> Stockton, CA 95206 <br /> Care of Michael Vilarino <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Michael Vllarino <br /> Title General Manager <br /> Day Phone 209-932-0495 <br /> Night Phone 209-649-8651 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0041814 New Account ID: <br /> Mail Invoices to Account Mail invoices to: Owner / Facility / Account <br /> Account Name Michael Vllarino (Circle One) <br /> Account Balance as of 6/5/2017: $0.00 <br /> (Circle One) <br /> Transfer to ActiveMaGve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0539856 EE0009817-ROBERT LOPEZ Active Y N A D <br /> 2220-SM HW GEN<5 TONSNR PR0539855 EE0001421 -STACY RIVERA Active Y N A D <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PRO539858 EE0001421 -STACY RIVERA Active Y N A D <br /> BILLING and COMPLIANCE ACKNOwLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andtor project specific.PHSIEHD hourly charges associated with this facility <br /> or allivAy will be billetl to the party identified as the ONMER on this form, I also certify that all operations will be Performed in accordance with all applicable Ordinance Codes andlor Standards and State anNor <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 Type CM Check Number e Received by ,�J <br /> EHD Staff: Date Account out: Date /.;-/ <br /> COMMENTS: nn <br /> VV I __�br.� L-,>�¢.� !7 � r"`l��'— 61;16 l��) Invoice#: <br /> oy -a z <br /> f,7tC o t�'�y C-TI MS joustYle SS 15 na /an5 e/' �c✓a,�r�'ty) zg32 <br /> �5 Vf ��� y <br />