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Date run 8/17/2011 9:17:06AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> ` <br /> Run by 1. 4066 Facility Information as of 8/17/2011 Pagel <br /> Record Selection Criteria: Facility ID FA0019326 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(dale) <br /> OWNER FILE INFORMATION SSN 1 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 /> I 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 <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 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOHNNY CAIN JR <br /> Title <br /> j 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 1 Account <br /> Account Name THIS JOB SUCKS (Circle One) <br /> Account Balance as of 811712011: $0.00 <br /> (Circle One) <br /> Transfer to Activelinactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PR0528846 EE0005944-MICHAEL ESCOTTO # - Y N A I D <br /> 4244-PUMPER TRUCK PRO530514 EE0005944-MICHAEL ESCOTTO Active Y N I D <br /> 4244-PUMPER TRUCK PR0536499 EE0005944-MICHAEL ESCOTTO Inactive Y N I D <br /> 4246-PUMPER YARD PR0536490 EE0005944-MICHAEL ESCOTTO Active,Exempt Y N I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSIEHD hourly charges associated with this <br /> faci4ity or actNily 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 /> PPPLICANT'S SIGNATURE: Date gtkz^ 117I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid ate 1 1 <br /> Water System to be TRANSFERED: Amount Paid $rs Date 1i-11f EN"� <br /> Payment Ty ✓ Check Number O Received by p.Y EJ'Je <br /> REHS: Dale el ! // Account out: Date <br /> COMMENTS: <br /> Ileh-envlenvision\reports15021.rpt <br />