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Date run 7/27/2011 9:27:15AM SAN(-"'LQUIN COUNTY ENVIRONMENTAL H .TH DEPARTMENT Report#5021 <br /> Run by r -. Pagel <br /> Facility Information as of 7/27/2011 <br /> Record Selection Criteria: Facility ID FA0019326 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <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 /> Home Phone 510-589-2876 <br /> WoWBusiness 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 Aft 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 /> j 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 (ClydeOne) <br /> Account Balance as of 7/27/2011: $0.00 <br /> (Cirde One) <br /> Transfer to ActiveMactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PRO528846 EE0005944-MICHAEL ESCOTTO Inactive Y N A I D <br /> 4244-PUMPER TRUCK PRO530514 EE0005944-MICHAEL ESCOTTO -ActivL--' Y N A 0 D <br /> 4246-PUMPER YARD PRO536490 EE0005944-MICHAEL ESCOTTO Active,Exempt 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 specifiF PHS/EHD hourly charges associated with this <br /> r 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 Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I I <br /> WaterSyste eTRANSFERED: Amount Paid Date ! <br /> Paymen h ber Received by <br /> RENS: �raC. Date! Z' 1� Account out: Dated_- iZl�� <br /> COMMENT <br /> Ileh-envlenvisionlreports15021 rpt <br />