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Date run 8/17/2018 2:09:05PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/17/2018 <br /> Record Selection Criteria: Facility ID FA0020223 <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: 3 SSN/Fed Tax ID <br /> Owner ID OW0002213 New Owner ID <br /> Owner Name ZUCKERMAN-HERITAGE INC <br /> Owner DBA ZUCKERMAN HERITAGE INC <br /> OwnerAddress PO BOX 487 <br /> STOCKTON, CA 95201 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-469-7979 <br /> Mailing Address PO BOX 487 <br /> STOCKTON, CA 95201 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0020223 10187547 <br /> Facility Name ZUCKERMAN HERITAGE INC <br /> Location 10500 N CORREIA RD <br /> LODI, CA 95242 <br /> Phone 209-469-7979 x <br /> Mailing Address PO BOX 487 <br /> STOCKTON, CA 95201 <br /> Care of ZUCKERMAN-HERITAGE INC <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 06901015 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 AR0036109 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ZUCKERMAN HERITAGE INC (Circle One) <br /> Account Balance as of 8/17/2018: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0536320 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2221 -USED OIL ONLY-<5 TONS/YR PR0538602 EE0000030-AARON HANG Active Y N A I D <br /> .�gg� AST FAC 10 K-</=100 K GAL CUMULATIVE PR0540199 EE0000030-AARON HANG Active Y N A I D <br />'i8��4740-WASTE TIRE SITE-EXEMPT PR0534973 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0536299 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will 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 Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S 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 <br /> EHD Staff: at Date 0,? / 17 / LL- Account out: 4tmDate g' 2- <br /> COMMENTS: <br /> C,1IC J P(Q0(C•m/F/e v7ei i rode Fro:r ;WR }o d,?30 fee, Invoice#: <br /> �tv%:5pe 6 t lar ('aY)(J_ U.JCC) ar 811'7/1,' <br />