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Date run 4/29/2016 4:33:01PA SAN JO "AN COUNTY ENVIRONMENTAL HEA' � DEPARTMENT <br /> Pagel <br /> Run by %W Facility <br /> #5021 <br /> Facility Information as of 4/29/201l <br /> Record Selection CriteriaFacility ID FA0023432 - <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 SSN 1 Fed Tax ID <br /> Owner ID OW0021667 New Owner ID <br /> Owner Name SALLY BEAUTY HOLDING LLC <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 940-898-7600 <br /> Mailing Address 3001 COLORADO BLVD <br /> DENTON, TX 76210 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID!CERS ID FA0023432 10667452 <br /> Facility Name COSMOPROF SUPPLY <br /> Location 1 110 W Kettleman Ln # 103 <br /> Lodi, CA 95240 <br /> Phone 940-898-7500 x <br /> Mailing Address 1110 W KETTLEMAN LANE #103 Id <br /> LODI, CA 95240 <br /> Care cf SALLY BEAUTY HOLDING LLC <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN Entail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0043194 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name DAVID EPSTEIN (Circle One) <br /> Account Balance as of 4/2912016: $0.00 <br /> (Circle One) <br /> Transfer to Activelinaci <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner"? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0540945 EE0001422-ARIS VELOSO Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent or same,acknowledge that all site,andior project specific,PHSlEHD hourly charges associated with this facility <br /> of activity will be billed to the partly identified as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andlar Standards and State andror <br /> Federal Laws <br /> APPLICANT'S SIGNATURE. Date / / <br /> Program Records to be TRANSFERED "$25.00= Amount Paid Date I 1 <br /> Water System to be TRANSFFRED Amount Paid Date ! / <br /> Payment Type I Check Number Received by <br /> EHD Staff A/ DateIIll. Account out: 4P5 Date �r ! <br /> COMMENTS. (� Invoice#: 279,9 5 <br />