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Dae mn ,11/112016 758:15Ak SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/1/2016 <br /> Record Selection Criteria: Facility ID FA0020534 <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 OW0016876 New Owner ID <br /> Owner Name JIM CADEL <br /> Owner DBA CADELL EQUIPMENT SALES <br /> Owner Address 11265 S HARLAN RD <br /> LATHROP, CA 95330 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-456-0020 <br /> Mailing Address 11265 S HARLAN RD <br /> LATHROP, CA 95330 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0020534 10187621 <br /> Facility Name CADELL EQUIPMENT SALES <br /> Location 11265 S HARLAN RD <br /> LATHROP, CA 95330 <br /> Phone 209-456-0020 x0 <br /> Mailing Address 11265 S HARLAN RD <br /> LATHROP, CA 95330 <br /> Care of <br /> Location Code 07 - LATHROP Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 19602007 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 AR0036738 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name JIM CADEL (Circle One) <br /> Account Balance as of 11/1/2016: $0.00 <br /> (ande One) <br /> Transfer to Activallnactve <br /> Ploxan rElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO535610 EE0000010-PETER LOMBARDI Active Y N AOI D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0535975 InactivE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site.andior project specific,PHS/EHD hourly charges associated with this facility or: <br /> be billed to the party identified as the OWNER on this form I also certity that all operations will be performed in accordance with all applicable Ordinance Codes ardor Standards and State ander Federal Laws. <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: Date--1.7 l--,- lff_ Account out 1�) Date <br /> COMMENTS: <br /> Invoice#: <br /> ZZ I <br />