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Date run 7/17/2013 10:01:53AI SAN JC. JIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/17/2013 <br /> Record Selection Criteria: Facility ID FA0021782 <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 OW0002612 New Owner ID <br /> Owner Name DORAN, JOE <br /> Owner DBA <br /> Owner Address 2416 VINTAGE OAKS CT <br /> LODI, CA 95242 <br /> Home Phone 209-367-1273 <br /> Work/Business Phone 209-948-9500 <br /> Mailing Address PO BOX 8810 <br /> STOCKTON, CA 95208 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0021782 <br /> Facility Name DORAN PROPERTY <br /> Location 2811 E FREMONT ST <br /> STOCKTON, CA 95202 <br /> Phone 209-367-1273 <br /> Mailing Address 2416 VINTAGE OAKS CT <br /> LODI, CA 95242 <br /> Care of JOE DORAN <br /> Location Code 01 -STOCKTON Alt Phone <br /> Bos District 001 -VILLAPUDUA Fax <br /> APN 14308024 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOE DORAN <br /> Title OWNER <br /> Day Phone 209-367-1273 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039608 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name FREMONT GATE LLC (Circle One) <br /> Account Balance as of 7/17/2013: $-625.00 <br /> (Circle One) <br /> Transfer to Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0537777 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 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 /> 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 /> COMMENTS: <br />