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Date run 0 12/18/2017 3:11:24P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/18/2017 <br /> Record Selection Criteria: Facility ID FA0020792 <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: 1 SSN/Fed Tax ID <br /> Owner ID OW0017095 New Owner ID <br /> Owner Name HOUSTON, DANNY R <br /> Owner DBA <br /> OwnerAddress 12684 E TOKAY COLONY RD <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-607-5459 <br /> Mailing Address 12759 E BRANDT RD STE D <br /> LOCKEFORD, CA 95237-9561 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0020792 10187689 <br /> Facility Name DAN HOUSTON CUSTOMS <br /> Location 12759 E BRANDT RD BT STE B <br /> LOCKEFORD, CA 95237 <br /> Phone 209-607-5459 <br /> Mailing Address 12759 E BRANDT RD STE D <br /> LOCKEFORD, CA 95237-9561 <br /> Care of HOUSTON, DANNY R <br /> Location Code Alt Phone <br /> BOS District 004-WIN N. CHARLES Fax <br /> APN 05131026 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DANNY R HOUSTON <br /> Title <br /> Day Phone 209-607-5459 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0037321 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name DAN HO STON CUSTOMS (CimleOne) <br /> Account Balance as of 12/18/2017: $2 L_ b �s <br /> (Circle One) <br /> Program/Element and Description Record ID Employee ID and Name Status Transfer to Active/InaMe <br /> New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PR0536187 EE0000030-AARON HANG Active Y N A<Z) D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0536188 EE0000030-AARON HANG 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,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. 1 also nertify that all operations will be performed in accordance with all applicable Ordnance Codes anclor 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 by <br /> EHD Staff: Date /�/�_ Account out: Date 1-2-1 L / 1-7 <br /> COMMENTS: <br /> Invoice#: <br />