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4Oate run , 10/29/2019 1:29:45P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/29/2019 <br /> Record Selection Criteria: Facility ID FA0010296 <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 OW0008296 Case Number: H07663 New Owner ID <br /> Owner Name E H EHLERS & SONS INC <br /> Owner DBA H EHLERS & SONS INC <br /> OwnerAddress 530 S MILLS AVE <br /> LODI, CA 95242 <br /> Work/Business Phone 209-334-5911 <br /> Alternative Phone Not Specified <br /> Mailing Address <br /> 4-0—' <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010296 10183419 <br /> Facility Name H EHLERS & SONS INC <br /> Location 9009 W HWY 12 <br /> LODI, CA 95240 <br /> Phone 209-334-5911 x0 <br /> Mailing Address PO BOX 2239 RETURN TO SENDER <br /> flG no MI n1\ E nL ET 3 tg'j' �V11� L 1VL r <br /> LODI, CA 95241 p p B O x 2 239 <br /> Care of H EHLERS & SONS INC LODI CA 95241-2239 <br /> Location Code 99- UNINCORPORATED A RETURN TO SENDER <br /> BOS District 004-WINN, CHARLES III Jill 11111111111111111111"'lJill <br /> APN 02508003 <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017296 NewAccount ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name E H EHLERS & SONS INC (Circle One) <br /> Account Balance as of 10/29/2019: $101.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525864 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512584 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0510296 EE0000000-HAZ MAT SJC OES InactiVE Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0530512 EE0000030-AARON HANG InactivE Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532025 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 and/or Standards and State and/or <br /> Federal Laws <br /> - <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 Rece ed y <br /> EHD Staff: Date / / Account out: Date / / <br /> COMMENTS: <br /> I voice#: <br />