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Date run 5/16/2019 8:38:27AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/16/2019 <br /> Record Selection Criteria: Facility ID FA0001041 <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: 2 SSN/Fed Tax ID <br /> Owner ID OW0009546 New Owner ID <br /> Owner Name CABRERA, JORGE <br /> Owner DBA <br /> OwnerAddress 10227 E HWY 26 <br /> STOCKTON, CA 95215 <br /> Work/Business Phone 209-931-1844 <br /> Alternative Phone 209-607-7544 <br /> Mailing Address 10227 E HWY 26 <br /> STOCKTON, CA 95215 <br /> Care of CABRERA, JORGE <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0001041 <br /> Facility Name RICHARDS PUMPING & EXCAVATING <br /> Location 10227 E HWY 26 <br /> STOCKTON, CA 95215 <br /> Phone 209-931-1844 <br /> Mailing Address 10227 E HWY 26 <br /> STOCKTON, CA 95215 <br /> Care of CABRERA, JORGE <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 08910012 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CABRERA, JORGE <br /> Title <br /> Day Phone 209-931-1844 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0001039 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name RICHARDS PUMPING & EXCAVATING (Circle One) <br /> Account Balance as of 5/16/2019: $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 /> 4244-PUMPER TRUCK PR0420029 EE0000644-TED NORGARD Inactive Y N A I D <br /> 4244-PUMPER TRUCK PR0517524 EE0009488-JEFFREY WONG Active Y N A I D <br /> 4246-PUMPER YARD PR0420052 EE0009488-JEFFREY WONG 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 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 and/or Standards and State and/or <br /> Federal Laws. J <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRA SFERED: "$25.00= Amount Paid Date <br /> Water System toTRANSFEREAeck�±ber <br /> Amount Paid Date / ! <br /> Payment Typ Received <br /> EHD Staff: Date /1_/ Account out: Date 5—/ 2 <br /> COMMENTS: 32� <br /> Invoice#: <br /> 40 A/&W U <br />