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Date run 10/31/2018 3:43:29F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 10/31/2018 <br />Record Selection Criteria: Facility ID FA0016699 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0013540 <br />Owner Name <br />ROY YONEMOTO <br />Owner DBA <br />ROY YONEMOTO <br />OwnerAddress <br />9269 S PRIEST RD <br />Phone <br />FRENCH CAMP, CA 95231 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />PO BOX 206 <br />Location Code <br />FRENCH CAMP, CA 95231 <br />Care of <br />001 - VILLAPUDUA, MIGUEL <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0016699 10185259 <br />Facility Name <br />ROY YONEMOTO <br />Location <br />9269 S PRIEST RD <br />FRENCH CAMP, CA 95231 <br />Phone <br />209-982-0733 x0 <br />Mailing Address <br />PO BOX 206 <br />FRENCH CAMP, CA 95231 <br />Care of <br />Location Code <br />99 - UNINCORPORATED A <br />Bos District <br />001 - VILLAPUDUA, MIGUEL <br />APN <br />19322036 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0029581 <br />Mail Invoices to Owner <br />Account Name ROY YONEMOTO <br />Account Balance as of 10/31/2018: $0.00 <br />Program/Element and Description <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Sum L <br />.t1 � � 1► <br />w <br />f ►� <br />AMU1 <br />1 <br />♦ .R I 1► r i <br />Alt Phone <br />Fax <br />EMail : <br />Record ID Employee ID and Name <br />New Account ID: <br />Mail Invoices to: Owner / <br />Status <br />Facility / Account <br />(Circle One) <br />(Circle One) <br />Transferto Active/Inactve <br />New Owner? Delete <br />• 1958 - HM -Farm Operations PR0524884 EE0002670 - MUNIAPPA NAIDU InactivE Y N A I D <br />2830 -AST FAC - SPCC EXEMPT PR0530542 EE0001459 - VICKI MCCARTNEY InactivE Y N A D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI PR0534313 InactiVE Y N A 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 and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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 b <br />EHD Staff: GfE� , 411/I Date l�]_l -l' ) Account out: Date U /_L/� <br />COMMENTS: <br />I <br />flW Ya�'t�,Invoice #: <br />