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D <br /> ale 3f712D17 12 44:46PM <br /> Run SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report#5021 <br /> Facility Information as of 3/7/2017 Pagel <br /> election Crifera. Facility ID FA0022697 <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 OW0020393 <br /> New Owner ID <br /> Owner Name DUQUE, ROSTY A <br /> Owner DBA <br /> Owner Address 157 S SIERRA AVE AVE D <br /> OAKDALE, CA 95361-4049 <br /> Home Phone 510-301-7953 <br /> Work/Business Phone Not Specified <br /> Mailing Address 157 S SIERRA AVE STE D <br /> OAKDALE, CA 95361-4049 <br /> Care of DUQUE, ROSTY A <br /> FACILITY FILE INFORMATION <br /> Facility ID!CERS ID FA0022697 1 �� <br /> Facility Name DUQUE BROTHERS <br /> Location 3661 S Hill 99 W FRONT AGE��� <br /> 1 <br /> STOCKTON, CA 95215 �} <br /> Phone 510-301-7953 d Mir 7-/W.'\.h L <br /> Mailing Address 157 S SIERRA AVE STE D <br /> OAKDALE, CA 95361-4049 <br /> Careof DUQUE, ROSTY A <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 001 - VILLAPUDUA, CARLOS Fax <br /> APN 17915017 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION . y! <br /> Contact Name ROSTY A DUQUE <br /> Title <br /> Day Phone 510-301-7953 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0041564 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner I Facility f Account <br /> Account Name DUQUE BR© RS E (Circle One) <br /> Account Balance as of 3/712017: $261;QO <br /> (Circle One) <br /> r. Transfer to Aetive/lnactve <br /> Program/Element and Description / R.,to Employee ID and Name Status New Owner? LleteIs <br /> 2220-SM HW GEN<5 TONS/YR ` PRO539657 EEDO00031 -ELIANNA FLORIDO Active 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,PHSYEHD hourly charges associated with thi {lily <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 andlor Standards and State andlor <br /> Federal Laws <br /> APPLICANT'S SIGNATURE: Date / 1 <br /> Program Records to be TRANSFERED, *$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED, Amount Paid Date—/—/ <br /> Payment Type Check.Number Received by <br /> EHD Staff: Date__3 l=/1_ 1:2 Account out: J_J Date f <br /> COMMENTS. <br /> 11 LL' n J Invoice#: <br /> o1JC @ +r1lPW ,�6GwT t'g"1 a 1-7 II L—a"D li("c Rt— <br />