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Datai , 11/4/2012 3:42:46PR SAN JOIN COUNTY ENVIRONMENTAL HEA10 DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/4/2012 <br /> Record Selection Criteria: Facility ID FA0021580 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002112 New Owner ID <br /> Owner Name SJC DELTA COLLEGE <br /> Owner DBA SAN JOAQUIN DELTA COLLEGE <br /> Owner Address 5151 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-954-5151 <br /> Mailing Address 5151 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0021580 <br /> Facility Name MOUNTAIN HOUSE SJ DELTA COLLEGE <br /> Location 2073 S CENTRAL PKWY <br /> MOUNTAIN HOUSE, CA 95391 <br /> Phone 209-833-7900 <br /> Mailing Address 5151 PACIFIC AVE LIM <br /> STOCKTON, CA 95207 <br /> Care of STACYPINOLA <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 005 - ORNELLAS, LEROY Fax <br /> APN 20908034 Entail: v � U <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name STACY PINOLA <br /> Title <br /> Day Phone 209-833-7900 °5 <br /> Night Phone E3 <br /> E3 b j If <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039079 New Account ID: <br /> Mail lnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MOUNTAIN HOUSE SJ DELTA COLLEGE (Circle One) <br /> Account Balance as of 12/4/2012: $0.00 <br /> (Circle One) <br /> Transfer to Acgvellnactve <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PR0537504 EE0002646-THUY TRAN Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,enmor 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 farm Ialso certifythat all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State ansur <br /> 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 NumberReceiv <br /> RENS: Date / /_ Account out: �Date / L2---, <br /> COMMENTS: <br />