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Dale run 1/2_7/2014 9:23:03Ah SAN JOIN COUNTY ENVIRONMENTAL HEAL-WEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/27/2014 <br /> Record Selection Criteria: Facility ID FA0019956 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) 422 —l <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0016379 New Owner lD <br /> Owner Name SILVESTREHERNANDEZ <br /> Owner DBA SILVESTRE'S CONST MECH CO <br /> Owner Address 6030 E KETTLEMAN LN <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-327-0749 <br /> Mailing Address PO BOX 2507 <br /> LODI, CA 95241 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0019956 10187463 <br /> Facility Name SILVESTRES CONST MECH CO <br /> Location 6030 E KETTLEMAN LN <br /> LODI, CA 95240 <br /> Phone 209-333-2608 x0 <br /> Mailing Address PO BOX 2507 <br /> LODI, CA 95241 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 06105013 EMai1: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0035535 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name SILVESTREHERNANDEZ (Circle One) <br /> Account Balance as of 1/27/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active4ri <br /> Program/Element and Descnption Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0530800 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 1962-CaIARP PROGRAM 2 FACILITY PR0536206 EE0000988-KASEY FOLEY Active Y N A I D <br /> 1995-CaIARP FAC STATE SURCHARGE FEE PR0536029 Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534577 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSEHD 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 ander Standards and State anclor <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment/T7vpe Check Number ( Received by <br /> RENS,: VL J OT I LAd Date ^/�^//�`�/.L. Account out: PDate <br /> l��/ 1� / <br /> COMMENTS: v P <br />