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Date run 612312016 3:01:23PR SAN JOAQIUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 6/23/2016 Pagel <br /> Record Selection Criteria: Facility ID FA0017515 <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 55N!Fed Tax ID <br /> Owner ID OW0014356 New Owner ID <br /> Owner Name STEPHEN M ALEGRE <br /> Owner DBA STEPHEN M ALEGRE <br /> Owner Address 21763 S LAMMERS RD <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> MailingAddress 21763 S LAMMERS RD <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017515 10186571 <br /> Facility Name STEPHEN M ALEGRE <br /> Location 24915 HANSEN RD <br /> TRACY, CA 95304 <br /> Phone 209-321-6819 x0 <br /> Maifing Address 21763 S LAMMERS RD <br /> TRACY, CA 95304 <br /> Care of <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 20912005 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name STEPHEN M ALEGRE <br /> Title OWNER <br /> Day Phone 209-321-6819 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030397 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner I Facility / Account <br /> Account Name STEPHEN M ALEGRE (Circle One) <br /> Account Balance as of 612312016: $1,956.00 <br /> (Circle One) <br /> Transfer to Active+inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operatlons PRO525700 EE0002670-MUNIAPPA NAIDU Active Y N A D <br /> 2220-SM HW GEN<5 TONS/YR PR0536104 EE0001459-VICKI MCCARTNEY Active Y N A D <br /> 2830-AST FAC -SPCC EXEMPT PR0530993 EE0001459-VICKI MCCARTNEY InactivE Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0536097 FE0002622-BENJAMIN ESCOTTO Active Y N A i D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532394 Ji Y N 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,PHSIEHD 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 anSor Standards and State and!or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <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: 447<-, Date -'?, Account out: Date ! f <br /> COMMENTS <br /> Invoice#: <br />