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Date run 11/27/2017 9:15:32A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by I A <br /> Paget <br /> Facility Information as of 11!27/2017 <br /> Record Selection Criteria: Facility to FA0017288 <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 OW0014129 New Owner ID <br /> Owner Name WILLIAM SARALE <br /> Owner DBA WILLIAM SARALE <br /> Owner Address 14600 E EIGHT MILE RD <br /> LINDEN, CA 95236 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-470-0747 <br /> Mailing Address PO BOX 7960 <br /> Care of STOCKTON, CA 95267 <br /> FACILITY FILE INFORMATION \`oO"ht\ <br /> Facility lD/CERS ID FA0017288 10186217 <br /> Facility Name WILLIAM SARALE <br /> Location 14600 E EIGHT MILE RD <br /> LINDEN, CA 95236 <br /> Phone 209-470-0747 X <br /> Mailing Address PO BOX 7960 <br /> STOCKTON, CA 95267 <br /> Care of William Sarale <br /> Location Code Alt Phone <br /> BOIS District Fax <br /> APN 09101008 �� EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title / 0 <br /> Day Phone ^�� <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> l�l r <br /> Account ID AR00301701 !� New Account ID: <br /> Mail Invoices to Account \^l �� Mail Invoices to: Owner / Facility / Account <br /> Account Name WILLIAM SARALE (Circle One) <br /> Account Balance as of 11/27/2017: $0.00 / �` C <br /> �< ��k ^O (Circle One) <br /> PrograMElement and Description Re ID Qim Io ee ID and Name Status Transfer to Activelete ve <br /> P Y New Owner? Delete <br /> 1958-HM-Farm Operations PR0525473 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO530384 EE0001421 -STACY RIVERA Active Y N A-'zZj D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO530383 EE9999998-ONE VACANT? Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531890 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT, I,the undersigned owner,operator or agent ofsame,acknowledge that all site,an&or project specific,PHSEHD 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 anclor Standards and Slate and/or <br /> Federal Laws. /// <br /> APPLICANT'S SIGNATURE: G!�/ V� Date <br /> Program Records to be TRANSFERED: *$25.00=- Amount Paid Date / � �/ <br /> Water System to be TRANSFERED: Amount Paid /.i / <br /> r <br /> Payment Type Check Number Received by lilt-.GL. <br /> EHD Staff: Date Account out: Date <br /> COMMENTS: �G/ <br /> l I/n A. Invol <br /> 'teZa.�- V3 _� <br />