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Date run 5/11/2015 8:54:10AR SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report p5021 <br /> Run by Pagel <br /> Facility Information as of 5/11/201 <br /> Record Selection Criteria: Facility ID FA0022809 <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 OW0020710 New Owner ID <br /> Owner Name SAN JOAQUIN HOUSING INVESTMENT GR( <br /> Owner DBA <br /> Owner Address 1209 E EIGHT ST <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1209 E EIGHT ST <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0022809 <br /> Facility Name CASA DE OASIS- MULTI-FAMILY HOUSING <br /> Location 1700 S EL DORADO ST <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 1209 E EIGHT ST <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 16703326 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 AR0041840 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CASA DE OASIS - MULTI-FAMILY HOUSING FACIL (Circle One) <br /> Account Balance as of 5/11/2015: $-195.00 <br /> (Circle One) <br /> Transfer to Activellnadve <br /> Program/Element and Description Record ID Employee IO and Name Status New Owner9 Delete <br /> 2950-ENVIRON ASSESS PR0539877 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge Nat all site,andor project specific,PHSfEHD 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 andor Standards and State andor <br /> Federal Laws <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date_/ / <br /> PaymenType Check Number Received by <br /> RENS: ffn/__I AAA Date / / Account out: Date 7 / <br /> COMMENTS: /j <br /> V-I/.-�4F.- <br /> 2,q6b n C <br />