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Date run 11/5/2018 4:16:06Ph SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/5/2018 <br /> Record Selection Criteria: Facility ID FA0017091 <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 OW0013932 New Owner ID <br /> Owner Name JOE P PRECISSI <br /> Owner DBA JOE P PRECISSI <br /> Owner Address 10895 E COMSTOCK RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-931-0836 <br /> Mailing Address 10895 E COMSTOCK RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017091 10185883 <br /> Facility Name JOE P PRECISSI <br /> Location 10895 E COMSTOCK RD <br /> STOCKTON, CA 95215 <br /> Phone 209-931-0836 x0 <br /> Mailing Address 10895 E COMSTOCK RD <br /> STOCKTON, CA 95215 <br /> Care of joe precissi <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 08913032 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 AR0029973 _ �j New Account ID: <br /> Mail Invoices to AccountW Mail Invoices to: Owner / Facility / Account <br /> Account Name JOE P PR SS (Circle One) <br /> Account Balance as of 11/5/2018: $ 01.00 <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 Operations PR0525276 EE0002670-MUNIAPPA NAIDU Active Y N I <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0529560 EE0000753-WILLY NG Inactive Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531294 Inactive 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,PHS/EHD 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 and/or Standards and State andlor <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 Type Check Number Received by <br /> EHD Staff: Date / / Account out: Date ( / / X <br /> COMMENTS: <br /> Invoice#: <br />