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Date run 611012016 11:38:58AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT p <br /> Run by Report 95021 <br /> Facility Information as of 6/10/2016 Pagel <br /> Record Selection Criteria: Facility ID FA0023509 <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 /> SSN/Fed Tax ID <br /> Owner ID OW0021779 New Owner ID <br /> Owner Name Barry FRAIN <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-462-0717 <br /> Mailing Address 330 N Grant St <br /> Stockton, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0023509 10671805 <br /> Facility Name con j franke warehouse 1 <br /> Location 330 N Grant St <br /> Stockton, CA 95202 <br /> Phone 209-462-0717 x0 <br /> Mailing Address 330 N Grant St <br /> Stockton, CA 95202 <br /> Care of Con J. Franke Electric, Inc. <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0043353 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CON J FRANKE ELECTRIC INC (317) (Circle One) <br /> Account Balance as of 611012016: $0.00 <br /> (Circle One) <br /> Transfer to ActiveJlnacive <br /> Program/Element and Description Record lD Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0541062 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 222D-SM HW GEN<5 TONSIYR PR0541061 EE0000015-TIMOTHY ENGLE Active Y N A I D <br /> 13ILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific,PHSlEHO hourly charges associated with this facility <br /> or activity will be billed to the party identified as the ciWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes ar for Standards and State andror <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date ! / <br /> Water System to be TRANSFERED. Amount Paid Date ! 1 <br /> Payment Type Check Number Received by <br /> EHD Staff: I Date 0 Account out: r'. Date I 1 <br /> COMMENTS: <br /> C. 9�f 0 N j-A-u ii T11 <br /> R 7 v + c�- CSS <br /> .5 Ntl_ ' <br />