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Date run 11/9/2011 1:35:37PN SAN JCWIN COUNTY ENVIRONMENTAL HEA*DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/9/2011 <br /> Record Selection Criteria: Facility ID FA0021089 <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 OW0017359 New Owner lD <br /> Owner Name WARNER, EUGENE <br /> Owner DBA FORMER BANK; NOT CURRENTLY OCC <br /> Owner Address 372 S LOCAN AVE <br /> FRESNO, CA 93727 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 372 S LOCAN AVE <br /> FRESNO, CA 93727 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0021089 <br /> Facility Name FORMER BANK; NOT CURRENTLY OCCUR <br /> Location 520 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Phone <br /> Mailing Address 520 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 13906032 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account lD AR0037977 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SAGIREDDY, P BABU (Circle One) <br /> Account Balance as of 11/9/2011: $0.00 <br /> (Circe One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omen Delete <br /> 2950-ENVIRON ASSESS PR0536710 EE0001699-JOHNNY YOAKUM 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 idenlBed as the OWNER on this form. I 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: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: Date ! / Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />