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Date win 12/1/2016 1:10:29PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/1/2016 <br /> Record Selection Cmem Facility ID FA0023453 <br /> Make changeslcorrections 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 OW0021694 New Owner ID <br /> Owner Name OEHRLE-STEELE, AARON <br /> Owner DBA <br /> Owner Address 25001 KASSON RD <br /> TRACY, CA 95304 <br /> Home Phone 209-835-7474 <br /> Work/Business Phone Not Specified <br /> Mailing Address 25001 KASSON RD <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0023453 <br /> Facility Name SKYDIVE CALIFORNIA LLC <br /> Location 25001 KASSON RD <br /> TRACY, CA 95304 <br /> Phone 209-835-7474 <br /> Mailing Address 25001 KASSON RD <br /> TRACY, CA 95304 <br /> Care of OEHRLE-STEELE, ARRON <br /> Location Code 03-TRACY Alt Phone <br /> BOS District Fax <br /> APN 23918005 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name OEHRLE-STEELE, ARRON <br /> Title <br /> Day Phone 209-835-7474 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0043232 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SKYDIVE CALIFORNIA LLC (Girds One) <br /> Account Balance as of 12/1/2016: $315.50 <br /> (Circle One) <br /> Transferto Active/Inachre <br /> PmgramlElement and Description Record ID Employee 10 and Name Status New Omen Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO540977 EE0008709-JAMIE LIMA Active 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 specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the Party identified as the OWNER on this form. 1 also candy that all operations will be performed In accordance with all applicable Ordinance Codes ander 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 Type Check Number Received by <br /> EHD Staff: Date 2 rIA6 Account out: / Date Z' / <br /> COMMENTS: <br /> Invoice#: <br /> / '/2<6/i" . <br />