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Date nm Report#5021 <br /> 2/17/2015 8:57:45Ak SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Regal <br /> Raney Facility Information as of 2/17/2015 <br /> Record Selection criteria: Facility ID FA0009875 <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: 2 SSN/Fed Tax ID <br /> Owner ID OW0007876 Case Number: H05705 New Owner ID <br /> Owner Name Bob Jones <br /> Owner DBA FORD CONST CO INC <br /> Owner Address 639 E LOCKEFORD ST <br /> LODI, CA 95240 <br /> Home Phone Not Specified FTW <br /> Work/Business Phone 209-333-1116 <br /> Mailing Address 639 E LOCKEFORD ST <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0009875 10182979 <br /> Facility Name FORD CONST CO INC <br /> Location 500 N CLUFF AVE <br /> LODI, CA 95240 <br /> Phone 209-333-1116 x _ <br /> Mailing Address -30 L0. I tc S� <br /> LOD(, CA 95240—^2-02--Z <br /> care of Ford Construction Company, Inc. <br /> Location Code 02 - LODI Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 04934013 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016875 New Account ID. <br /> Mail Invoices to Facility Mail Invoices to. Owner / Facility / Account <br /> Account Name FORD CONST CO INC (Circle One) <br /> Account Balance as of 2/17/2015: $2,768.00 <br /> (circle One) <br /> Transfer to ActiveArial <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 1921 -HMBP-Regular-Primary Location PRO619931 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512163 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PR0514074 EE0001422-ARTS VELOSO Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509875 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PR0516579 EE0001422-ARIS VELOSO Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0524531 EE0000060-JENNIFER FRASE Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532208 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,endor project specific,PHS(EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER onlhisfern. lalso certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State and1w <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: 1 '`�t V 1—� • 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 /> RENS: Date / / Account out: Date <br /> COMMENTS: <br />