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Date run 7/1/2020 11:38:29AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/1/2020 <br /> Record Selection Criteria: Facility ID FA0022259 <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 OW0018543 New Owner ID <br /> Owner Name PORT OF STOCKTON, ROUGH & READY <br /> Owner DBA <br /> OwnerAddress 2201 W WASHINGTON ST <br /> STOCKTON, CA 95201 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 209-946-0246 <br /> Mailing Address 2201 W WASHINGTON ST <br /> STOCKTON, CA 95201 <br /> Care of ESCOBAR, STEVE <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0022259 <br /> Facility Name PORT OF STOCKTON, ROUGH & READY <br /> Location 23 HOOPER DR <br /> STOCKTON, CA 95203 <br /> Phone <br /> Mailing Address 718 MCCLOY AVE <br /> STOCKTON, CA 95203 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 003 - PATTI, TOM Fax <br /> APN 16203007 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0040627 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ENVIRONMENTAL RISK SERVICES .q CQ— (Circle One) <br /> Account Balance as of 7/1/2020: $0.00 N o c-[4- .4H 71,0I 5 zol+ <br /> Circle One <br /> NJ►1 Transfer to Active/Inact e <br /> Program/Element and Description Record ID Employe and Name Status New Owner? / elete <br /> 2950-ENVIRON ASSESS PR0538761 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 andlor Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date L/ <br /> Program Records to be TRANSFE D: 25.00= ount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received <br /> EHD Staff: Date / / Account out: — Date <br /> COMMENTS: <br /> If1V01Ce#: <br />