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Date run 211212014 2:45:00PR SAN JO' IN COUNTY ENVIRONMENTAL HEAI'� DEPARTMENT Report 95021 <br /> Run by �� - 'Paget <br /> Facility Information.as of 2/12/2014 <br /> Record Selection Criteria: Facility ID FA0017488 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNI Fed Tax 1D <br /> Owner ID OW0014329 New Owner ID : <br /> Owner Name EDWARD KING <br /> Owner DBA EDWARD KING <br /> Owner Address 18700 NIJOEL WAY <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 18700 NIJOEL WAY. <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility IDICERS ID FA0017488 10,186,523 . <br /> Facility Name EDWARD KING <br /> Location 18700 NIJOEL WAY <br /> STOCKTON, CA 95215 <br /> Phone 209-467-1725 x0 <br /> Mailing Address 18700 NIJOEL WAY <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 18502032 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> P <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030370 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name EDWARD KIN (Circle one) <br /> ' Account Balance as of 2/12/2014: $53 Q <br /> (Circle One) <br /> Transfer to Activellnactve <br /> PrograrnlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations _ PR0525673 Active Y N A 7 D <br /> i X2840-=AST'EXEMPT-FAC' <-1;320 GPiL �, PR4530723, EE0000753-WILLY NG Active,! Y N , A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534640 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andror project speck,PHS/EH❑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%W1 be performed in accordance with all applicatNe Ordinance Codes and'or standards and State andfor <br /> Federal Laws. <br /># APPLICANTS SIGNATURE: 'Date / ! <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date I ! <br /> Water System to be TRANSFERED: Amount Paid Date I 1 <br /> Payment Type Check Number Receiv y <br /> RENS: X10,NkrL-_ Date _! I Account out: - Date _1 <br /> COMMENTS: <br /> pI-,ArLJIv40- <br />