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Dalaw` 219/2011 11:51:41AM SAN JOAr"IIN COUNTY ENVIRONMENTAL HEALTU DEPARTMENT Report xsort <br /> amby 5290Pagel <br /> Irl Facility Information as of 2/9/201solllo <br /> Record Selection CrfttL Facary,ID FA0017009 <br /> Make changes/corrections In RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013850 New Owner ID <br /> Owner Name ROBERT J BARBER <br /> Owner DBA ROBERT J BARBER <br /> Owner Address 28949 CAMERON RD <br /> GALT, CA 95632 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 28949 CAMERON RD <br /> GALT, CA 95632 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017009 <br /> Facility Name ROBERT J BARBER <br /> Location 28949 CAMERON RD <br /> GALT, CA 95632 <br /> Phone 209-794-2175 x0 (!)D^ <br /> Mailing Address 28949 CAMERON RD <br /> GALT, CA 95632 <br /> Care of <br /> Location Code All Phone <br /> BOS District Fax <br /> APN 00111019 EMall: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029891 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name ROBERT J BARBER (Circle One) <br /> Account Balance as of 2/9/2011: $67.00 <br /> IQrd One) <br /> PrognaMElement and!DescriptionRecMO ID Employee ID and Name status Transfer to Acuvennative <br /> New OwneO Delete <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525194 Active Y N A D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO530526 EE0000753-WILLY NG Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0531266 Active Y N A fjl D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,Ne undersigneo owner operator or agent of same,acknoMedge Mal all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity MN 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 Ordinate Codes and/or Slandands and <br /> State and/or 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 ReceivejJ b <br /> REHS: Date / / Account out: �7 Date 0 / <br /> COMMENTS: <br /> \\eh-envlenvision\reports\5021.rpt <br />