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Date run 11g12018 11:57:36AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repan#5021 <br /> Run by Pagel <br /> Facility Information as of 1/9/2018 <br /> Record Selection Criteria: Facility ID FA0014402 <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 1 Fed Tax ID <br /> Owner ID OW0011444 New Owner ID <br /> Owner Name Daren R Young <br /> Owner DBA DRYCO CONSTRUCTION INC <br /> Owner-Address 42745 BOSCELL RD <br /> FREMONT, CA 94538 <br /> Home Phone 510-438-6500 <br /> Work/Business Phone 510,-438-6500 <br /> Mailing Address 42745 Boscell Road <br /> Fremont, CA 94538 <br /> Care of YOUNG, DAREN <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0014402 10737034 <br /> Facility Name DRYCO Construction Inc. <br /> Location 4250 E Mariposa Rd <br /> Stockton, CA 95215 <br /> Phone 510-438-6500 X <br /> Mailing Address 4250 E Mariposa Road <br /> Stockton, CA 95215 <br /> Care of Dryco Construction Inc. <br /> Location Code 99-UNINCORPORATED ARE Alt Phone <br /> BOO District 004-WINN, CHARLES Fax <br /> APN Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024482 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name Jorge Flores Jr. (Circle one) <br /> Account Balance as of 11912018: $0.00 <br /> (Circle One) <br /> Tratlslerto Activellnactue <br /> ProgramfElarnent and Description Record ID Employee lD and Name Status New Owner? Delete <br /> 1921-HMBP-Regular-Primary Location PRO519260 EE0008709-JAMIE LIMA Active Y N A I D <br /> 2220/-SM HW GEN<5 TONSIYR PRO542027 EE0000031-ELIANNA FLORIDO Active Y N A I D <br /> I t 22 ABOVEGROUND STORAGE TANK(AST)PROGRA R0528053 EE0001421-STACY RIVERA Inactive Y N A I D <br /> /J 1 BILLING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned ow r,opeRLacocag same,acknowledge that all site,and/or project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this farm. 1 also certify that all operations will be performed In accordance with all applicable Ordinance codes and/or Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFEREE: °$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date ! 1 <br /> Payment Type Check Number Received,b <br /> EHD Staff: Date yl�CA / 1% Accountout: Date 17,2-! <br /> COMMENTS: Invoice <br /> Qrogca lelcm-"A a`�31 <br />