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Data ran 6/11/2013 8:57:10AR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 6/11/2013 <br /> Record Selection Criteria: Facility ID FA0012769 <br /> Make changes/corrections in RED ink <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner l0 OW0009948 New Owner ID <br /> Owner Name GONZALEZ, SALVADOR <br /> Owner DBA SALVADOR GONZALEZ LABOR CONT <br /> Owner Address 217 FOURTH ST <br /> GALT, CA 95632 <br /> Home Phone 209-745-2223 <br /> Work/Business Phone Not Specified <br /> Mailing Address 217 FOURTH ST <br /> GALT, CA 95632 <br /> Care of GONZALEZ, SALVADOR <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0012769 <br /> Facility Name SALVADOR GONZALEZ LABOR CONTRACT <br /> Location 10065 KOST RD <br /> GALT, CA 95632 <br /> Phone 209-745-2223 <br /> Mailing Address 217 FOURTH ST <br /> Care of GALT, CA 95632 PAYMENT <br /> ��cmtVED <br /> Location Code 99- UNINCORPORATED PAft Phone <br /> BOS District 004 -VOGEL, KEN 'JON 1 1 LU Fa <br /> JOAQ <br /> APN c3AN UIN COUlail: <br /> V,NVIHOM�NTA6 <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION„ppI:TH UgpppTMENT <br /> Contact Name GONZALEZ, SALVADOR <br /> Title VIN#1 HSLCZVN2JH569231 <br /> Day Phone 209-745-2223 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021369 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SALVADOR GONZALEZ LABOR CONTRACTOR (Circle One) <br /> Account Balance as of 6/11/2013: $0.00 <br /> (Circle One) <br /> Transfer to Activefinactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Ovmeo Delete <br /> 4244-PUMPER TRUCK PR0516744 EE0005944-MICHAEL ESCOTTO Active Y N A I D <br /> 4246-PUMPER YARD PRO536483 EE0005944-MICHAEL ESCOTTO Active,l Y N A 1 D <br /> 4255-CHEMICAL TOILETS PRO516745 EE0005944-MICHAEL ESCOTTO Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the ndersignad owner,operator or agent of same,acknowledge that all site,ars or projw specific.PHSIEHD hourly charges assouated with this facility <br /> or activity wdl be billed to the party identified s the O ER this form I also certify that all operations will be performed In smordance with all applicable ONinanoe Codes andor Standards and State ands <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: ate �/�// <br /> / Program Records to be TRANSFERE FV .$25.00= Amount Paid 1h'S — Date__Ze_/_LL/_� <br /> Water SysjqDVAbe TRANSFERED: Amount Paid Date / / <br /> Payme ✓ Che uNumber 7 Receiv <br /> REHS: Date�/ // /__4.5' Amount out: Date / /4_5 <br /> COMMENT s <br /> Cis �S 9o�.,t .r Pun. 7,1,4-1L.6, P;z D 5 nv� <br />