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Date mo 12/2/2015 10:52:31AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 12/2/2015 <br /> Record Selection Criteria: Facility ID FA0019833 <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 OW0016273 New Owner ID <br /> Owner Name OTTONE, TIMOTHY & DEBRA <br /> Owner DBA ENVIRONMENTAL PUMPING SERVICE <br /> Owner Address 10241 GOLDEN MEADOW CIR <br /> SALINAS, CA 93907 <br /> Home Phone 530-902-4372 <br /> Work/Business Phone 831-809-6483 <br /> Mailing Address 1 ?It p 1( to 4�/0 <br /> s�7 C-L,�,r GA q.<q a <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019833 <br /> Facility Name ENVIRONMENTAL PUMPING SERVICE <br /> Location 6059 BRADSHAW <br /> SACRAMENTO, CA 95829 <br /> Phone 530-9024372 1 1 <br /> 2t, <br /> Mailing Address 19 ^^ lito ME GIRD � � � X 6 -1 Cr 0 <br /> Davi <br /> C In,co , c A 9S-5Z-7 - 6y O <br /> Care of OTTONE, DEBRA <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN OUT OF COUN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name OTTONE, DEBRA <br /> Title <br /> Day Phone 530-902-4372 <br /> Night Phone 831-809-6483 Cell <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0035304 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ENVIRONMENTAL PUMPING SERVICE (Circle One) <br /> Account Balance as of 12/2/2015: $158.00 <br /> (Circle One) <br /> Transferto Activa/Inachve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PRO530331 EE0005944-MICHAEL ESCOTTO Active Y N A I D <br /> 4246-PUMPER YARD PRO536476 EE0005944-MICHAEL ESCOTTO Active,l Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,anNor project speci0c,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party Identified as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ani <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 /> EHD Staff: Date_/ / Account out: Date 4Z 1 Q, <br /> COMMENTS: <br /> Invoice#: <br />