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Date run 2/17/2015 8:57:45AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Runty r Pagel <br /> Facility Information as of 2/17/2015 <br /> Record Selection Criteria- Facility 10 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 OW0007875 Case Number: H05705 New Owner 1D <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 O C��� <br /> Work/Business Phone 209-333-1116 4 r <br /> Mailing Address 639 E LOCKEFORD ST <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/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 62P E t ^wEFORD ¢T 365 <br /> LODI, CA 95240--7J0ZZ <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 Ona) <br /> Transferto Active/lnactve <br /> PropramlElement and Description Record ID Employee ID and Name Status New Omar? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO519931 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512163 EE0000o00-HAZ MAT SJC DES Inactive Y N A 1 D <br /> 2227-GEN 5<25 TONS PERMIT PR0514074 EE0001422-ARIS 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 PR0624531 EE000GO60-JENNIFER FRASE Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532208 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the underegned owner,operator or agent of same,acknowletlge that all site,ander project specific.PHSEHD hourly charges associated with this facility <br /> or activity will b,billed to the party,dentmed as the OWNER on this forth. Ialso certify that all operations will be performed in accordance with all applicable Ordinance ewes andlor Standards and State andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: 1 r��t V I—`� •u 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 /> REHS: Date Account out: Date <br /> COMMENTS: <br />