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Date run 12/15/2014 8:56:41A SAN JO,,,,JIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/15/2014 <br /> Record Selection Criteria: Facility ID FA0016415 <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 OW0013288 New Owner ID <br /> Owner Name JUEN LEE <br /> Owner DBA MERIT SANITARY SUPPLY CO INC <br /> Owner Address 540 HUNTER ST <br /> STOCKTON, CA 95202 <br /> Home Phone Not Specified <br /> Work/Business Phone 530-292-3223 <br /> Mailing Address 540 HUNTER ST <br /> STOCKTON, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016415 <br /> Facility Name MERIT SANITARY SUPPLY CO INC <br /> Location 540 HUNTER ST <br /> STOCKTON, CA 95202 <br /> Phone 209-466-0181 x0 <br /> Mailing Address 540 HUNTER ST <br /> STOCKTON, CA 95202 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0028876 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to. Owner if Facility / Account <br /> Account Name JUEN LEE (Circle One) <br /> Account Balance as of 12/15/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0524472 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 andror Standards and Stale 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 Received by <br /> REHS. Date / / Account out: Date <br /> t"--'"4ENTS: <br /> '`rr <br />