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Rate ryn 6/15/2015 12:10a OPlSAN JOO Pagel <br /> COUNTY ENVIRONMENTAL HEA18 DEPARTMENT 50zt <br /> Run by Pagel <br /> Facility Information as of 6/15/2015 <br /> Record Selection Criteria: Facility ID FA0015207 <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: 4 SSN/Fed Tax ID <br /> Owner ID OW0002796 New Owner ID <br /> Owner Name San Joaquin Co. Mosquito&Vector Control Di <br /> Owner DBA <br /> Owner Address 7759 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-982-4675 <br /> Mailing Address 7759 S. Airport Way <br /> Stockton, CA 95206 <br /> Care of SJC MOSQUITO &VECTOR CONTROL <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0015207 <br /> Facility Name SJC MOSQUITO &VECTOR CONTROL DISI <br /> Location 200 N BECKMAN RD <br /> LODI. CA 95240 <br /> Phone 209-368-5132 <br /> Mailing Address 7759 S AIRPORT WY <br /> STOCKTON, CA 95206 <br /> Care of SJC MOSQUITO ABATEMENT <br /> Location Code 02- LODI Alt Phone <br /> BOS District 004-WINN, CHARLES Fax <br /> APN 04905031 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SJC MOSQUITO ABATEMENT <br /> Title <br /> Day Phone 209-368-5132 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026118 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name (Circle One) <br /> Account Balance as of 6/15/2015: $0.00 �ASdA) l,ESr�LJA oRtE <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 PR0522015 EE0000942-MARGARET LAGORIO Active Y N QA 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge Nal all site,andror project specific,PHS'EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on thisform I also certify Nat all operations will be performed in accordance with all applicable Ordinance Codes anNor Standards and State and/or <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 Receive b <br /> EHD Staff: ASA AVC ova Date AccouDate <br /> COMMENTS: <br /> Invoice#: <br />