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Date run 812112009 10:46:21AI SAN J( IUIN COUNTY ENVIRONMENTAL HE�'�H DEPARTMENT Report#5021 <br /> Run by ;, Paget <br /> Facility Information as of 8/21/2009 <br /> Record Selection Criteria: Facility ID FA0019326 <br /> Make changes/corrections in RED iink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Tax <br /> Owner ID OW0015860 �,UG 2 1 �� New Owner p ID <br /> Owner Name CAIN, JOHNNY C JR <br /> Owner DBA THIS JOB SUCKS �NVIR( `ti�� kAL <br /> Owner Address T p �M� �S RIf��i�5 gax � <br /> STOCKTON, CA 95306- <br /> Home Phone 510-589-2876 <br /> Work/Business Phone 209-601-8655 <br /> Mailing Address 4114 VAN GOGH CT <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019326 <br /> Facility Name THIS JOB SUCKS <br /> Location <br /> STAGKzF-9N, CA 95206 <br /> Phone 510-589-2876 xCELL <br /> Mailing Address <br /> i S-Teei(T-w CA 95206 <br /> Care of JOHNNY CAIN JR <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16614028 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOHNNY CAIN JR <br /> Title <br /> i Day Phone 510-589-2876 Cell <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034346 New Account lD <br /> Mail Invoices to Facility Mail Invoices to: Owner ! Facility 1 Account <br /> Account Name THIS JOB SUCKS (circle one) <br /> Account Balance as of 812112009: $0.00 <br /> (Circle One) <br /> Transfer to Activelinactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PR0528846 EE0005944-MICHAEL ESCOTTO Active Y N A f D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of some,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 and/or federal Laws. <br /> APPLICANT'S SIGNATUREX, Date 1 c, LI <br /> Program Records to be TRt—. rCRED: *$20.00!= Amount Paid Date 1 ! <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date—/—/ <br /> Payment Type Check Number Received bby Vim. <br /> REHS: /� �/ Date ! / "1 Account out: Date/2't 1 <br /> COMMENTS: <br /> a <br /> 11eh-envlenvisionlreports15021.rpt <br /> I <br />