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Date run 10111/2017 3:02:55F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 95021 <br />Run by PagelFacility Information as of 10/11/2017 <br />Record Selection Criteria: Facility ID FA001 7274 <br />OWNER FILE INFORMATION Number of facilities for this owner: 3 <br />Owner ID <br />OW0008039 Case Number: H06312 <br />Owner Name <br />R & J Dondero Inc <br />Owner DBA <br />R&J DONDERO INC <br />Owner Address <br />20480 E COPPEROPOLIS RD <br />Active <br />LINDEN, CA 95236 <br />Home Phone <br />209-931-1751 <br />Work/Business Phone <br />209-931-1751 <br />Mailing Address <br />20480 E Copperopolis Rd. <br />AD2830 <br />Linden, CA 95236 <br />Care of <br />ROBERT DONDERO <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0017274 10186191 <br />Facility Name R&J DONDERO <br />Location 20120 E COPPEROPOLIS RD <br />LINDEN, CA 95236 <br />Phone 209-931-1751 x0 <br />Mailing Address 20480 E COPPEROPOLIS RD <br />LINDEN, CA 95236 <br />Care of <br />Location Code 99 - UNINCORPORATED P <br />Bos District Q04 - WINN, CHARLES <br />APN 18322001 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN I Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0030156 <br />Mail Invoices to Facility Mail Invoices to: <br />Account Name R&J DONDERO <br />Account Balance as of 1011112017: $0.00 <br />New Account ID: : <br />Owner / Facility 1 Account <br />(Circle One) <br />(Circle One) <br />Transfer to Activellnactve <br />ProgramlElement and Description <br />Record ID <br />Employee ID and Name <br />Status <br />New Owner? <br />1958 - HM -Farm Operations <br />PR0525459 <br />EE0002670 - MUNIAPPA NAIDU <br />Active <br />Y N <br />D2220 <br />A(7D <br />- SM HW GEN <5 TONSIYR <br />PR0529707 <br />EE0001421 - STACY RIVERA <br />Active <br />Y N <br />AD2830 <br />- AST FAC - SPCC EXEMPT <br />PR0529706 <br />EE0000027 - CINDY VO <br />Inactive <br />Y N <br />A <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG <br />PR0534286 <br />Inactive <br />Y N <br />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 <br />Ordinance Codes <br />andfor Standards and State andlor <br />Federal Laws. <br />APPLICANT'S SIGNATURE: Date I I <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: <br />COMMENTS,. <br />$25.00 = <br />Date 1 1 <br />Amount Paid Date -/-/ <br />_ Amount Paid Date 1 1 <br />Receivedy <br />Account out: Date ! I <br />Invoice #: <br />