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FD.te 2/3/2017 9:28:OlAMSAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report*5321 <br /> Facility Information as of 2/3/2017 PBQet <br /> Record Selection Catena: Facility ID FA0017288 <br /> Make changes/corrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 OWNERSHIP CHANGE(date) <br /> New/Fed Tax ID <br /> Owner ID <br /> 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 /> STOCKTON, CA 95267 <br /> Care of <br /> FACILITY FILE INFORMATION <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 /> BOB District Fax <br /> APN 09101008 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION FEB 0 J 2017 <br /> Account ID AR0030170 'ENVIRONMENTAL HEALTH New Account to: <br /> Mail Invoices to Account PERMIT/SERVICES Mail Invoices to: Owner / Facility / Account <br /> Account Name WILLIAM SARALE (Circe One) <br /> Account Balance as of 2/3/2017: $306.00 <br /> (Circe one) <br /> Transfer to ActivaMame <br /> Program/Element and Description Record ID Employee ID and Name status New Owner! Delete <br /> 1958-HM-Farm Operations PRO625473 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 I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0530383 EE0000006-HAZA SAEED 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 of Same,acknowledge that all site,ander project spark,PHSrEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certity Nat all operations will be performed in accordance with all applicable Ordinance Codes andor standards and state andor <br /> Federal Lewd <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 Number Received by <br /> EHD Staff: M - nkH w� Date Account out:-- -�2— _ Date "A-- <br /> COMMENTS: <br /> Invoice#: <br />