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DatVif 2/3/2012 2:52:34PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information aS of 2/3/2012 Pagel <br /> Record Selection Criteria: Facility ID FA0019326 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION RIALESSN/Fed Tax ID <br /> Owner ID OW0015860 New Owner ID <br /> Owner Name CAIN, JOHNNY C JR <br /> Owner DBA THIS JOB SUCKS <br /> Owner Address 11530 W EIGHT MILE RD <br /> STOCKTON, CA 95219 <br /> Home Phone 510-589-2876 <br /> Work/Business Phone 209-601-8655 <br /> Mailing Address 11530 W EIGHT MILE RD BOX 27 <br /> STOCKTON, CA 95219 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019326 �if� GT ✓� �G� <br /> Facility Name THIS JOB SUCKS <br /> Location 11530 W EIGHT MILE RD <br /> STOCKTON, CA 95219 <br /> Phone 510-589-2876 xCELL <br /> Mailing Address 11530 W EIGHT MILE RD BOX 27 <br /> STOCKTON, CA 95219 <br /> Care of JOHNNY CAIN JR <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16614028 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOHNNY CAIN JR <br /> Title <br /> Day Phone 510-589-2876 Cell <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034346 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name THIS JOB SUCKS (circle One) <br /> Account Balance as of 2/3/2012: $316.00 <br /> (Circle Ona) <br /> Transfer to Active/InaGva <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PRO528846 EE0005944-MICHAEL ESCOTTO -Aetive- Y N A D <br /> 4244-PUMPER TRUCK PR0530514 EE0005944-MICHAEL ESCOTTO Y N A D <br /> 4244-PUMPER TRUCK PR0536499 EE0005944-MICHAEL ESCOTTO Inactive Y N A ��I\\ D <br /> ;Exempt� <br /> 4246-PUMPER YARD PR0536490 EE0005944-MICHAEL ESCOTTO *ctiveY N A U 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 <br /> facility 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 Ordinace Codes and/or Standards and <br /> State anclor Federal Laws. I <br /> APPLICANTS SIGNATURE: Si—a;% 1 rrr+l Date / 3 ! 12�— <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 Receivedb _ <br /> RENS: Date / / Account out: Date / .5 / ( <br /> Z <br /> COMMENTS: <br /> 11eh-envlen visionlreports15021.rpt <br />