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Date run 6/15/2010 12:49:37PI SAN JOAtW COUNTY ENVIRONMENTAL HEAL :EPARTMENT Report#5027 <br /> Run by Pagel <br /> Facility Information as of 6/15/2010 <br /> Record Selection Criteria: Facility ID FA0019490 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION �� SSN/Fed Tax ID <br /> Owner ID OW0015972 New Owner ID <br /> Owner Name FOPPIANO, HENRY <br /> Owner DBA <br /> Owner Address 11521 W EIGHT MILE RD <br /> STOCKTON, CA 95219 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 11521 W EIGHT MILE RD <br /> STOCKTON, CA 95219 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019490 Lo <br /> Facility Name �j,j, i1J�l +-�'tr St,rAn <br /> Location 1 T lvu'u�u�i� <br /> ST <br /> Phone - <br /> Mailing Address <br /> Care of Iti tgw e oo�uvl l a <br /> Location Code 99-UNINCORPORATED P <br /> BOS District 004-VOGEL, KEN <br /> APN 07108047 rµ� <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION Z �J° W U i4t� <br /> Contact Name �•'L 3� <br /> Title <br /> Day Phone I� II,, 61AI <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION AalGP �• � ' <br /> Account ID AR0034650 -. <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility I Account <br /> Account Name KLEINFELDER INC (Circle One) <br /> Account Balance as of 6/15/2010: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PRO529234 EE0003611 -FRANK GIRARDI Active 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 <br /> facility or activity will be billed to the party identified as the OWNER on this form. 1 also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> Stale and/or Federal Laws. ,— <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Received <br /> by- <br /> REHS: Date / / Account out: " r Date �/�_/ it b <br /> COMMENTS: <br /> \\eh�nv\envision\reports\5021.rpt <br />