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02/1412011 10:57 2094640138 � ,�. ENVIRONMENTAL HEALTH -. PAGE 91/01 <br /> 1 , <br /> 2/14/20111 T 0;5&3sai SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repo"05021 <br /> Run by - Paget <br /> Facility Information as of 2/14/2011 <br /> Record Seleelton CrWo: Fad1y ID FA0002925 <br /> Matte changes/corneotions in RED Ink. 2-2$='1 1 <br /> INFORMATION CHMGE(dgte) <br /> OWNERSHIP CHANGE(date) 2-2 8-1 1 <br /> OWNER.FILE INFORMATION SSN/Fed Tax ID : 547--52-1 656 <br /> Owner ID OW0002184 New Owner ID : - <br /> Owner Name CHAN,PAUL <br /> Owner08A MORADA MOBILE HOME PARK The Bell Living-..Trust Christine Bell <br /> Owner Address 19 TREESIDE CT 4833 __Full Moon Drive _w <br /> S SAN FRANCISCO,CA 94080 <br /> Horne phone Not SpeGfiAd --S c�hra n tp_-- Ca 9 4 R 0'1 <br /> Workffiusiness Phone Not Specified d R V111 1 lylcnnn _rir iva <br /> Malting Address 19 TREESIDE CT _ g � Ca 9 4 8 0 3�. �. <br /> S SAN FRANCISCO,CA 94080 <br /> care of PAUL CHAN <br /> FACILITY FILE INFORMATION <br /> FadEity ID FA0002925 <br /> Facility Name MORADA MOBILE HOME PARK Morada Mobile Home Par <br /> _ y_._ <br /> Location _8454.N-HWY 99. - -_ -==9 4 5 4'N'=HWY�=9 9 -- .. <br /> STOCKTON, CA 95212 _,St•nrk t on , Ca 959119 <br /> Phone <br /> Mailing Address 19 TREESIDE CT 4833 Full Moon Drive <br /> S SAN FRANCISCO,CA 94080 R1 Robrante, Ca 94803 <br /> Carve of PAUL CHAN -. <br /> Location Code 99-UNINCORPORATED P -Alt Phone <br /> SOS District 004-VOGEL,KEN Fax - <br /> APN 08515006 EMell: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION _ <br /> Contact Name PAUL CHAN David Bell 510 390-0867 <br /> Title <br /> Day Phone <br /> Nignt Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002436 New Account M <br /> Mail Invoices to Facility Mail Invoices to: Owner I Facility I Account <br /> Account Name MORADA MOBILE HOME PARK (ureuiona) <br /> Account Balance as of 2/1412011: $0.00 <br /> (GIrcle anal <br /> Prograrn/Erement end OwaWpIlon' Retard 1D Fmptoveo ID erd Name 5ralua Trw0mar4mvirrD ArllDORM ve <br /> ' NawOevaerr octets <br /> ...4242-WASTE WATtc. PLANT-Y,� ..PR0420079- -EE0005944-MICHAEL ESCOTrO—ActiVe, �-_ .� --Y.- -,.N---A 1�=.D <br /> BILLING And COMPUANCE ACKNOWLEDOEMEW: 1,Iha urtdeasrynad amer,opgre0ar aragenr of some,admowsedge IhA!ag alra,enWar projeer apogrtc,PtiSrEHn Ro4ry Charpea eaeaBarad w�1t tNe <br /> radrfty of AdMywln be brded to iha party IdangAad as the OWNER an drro form. r also calpy that an epemllcmd*+Id ba parrolmad irr aeoarderraa wllh efl apppcaple Qrd1nare Codeo and/or standards#ind <br /> Mars ands?Federal Lava. <br /> 6 <br /> APPL.ICAt-JrS SIGNATURE: • Date <br /> Program Records to be TRANSFERE~D: 25.no= Amount Paid Date I I <br /> Water System to beTRANSFERED: Amount Paid �Date ;- IaZI fl - <br /> PayrnentT ✓ Check Number 161 Received by _��. <br /> REHS: ,_Date ---Z—l� I Account out data �! Z3 I <br /> � S6n Post-it"Fax Note 7671 Qsla,� t I I,agss► __... ..__ w. <br /> To From <br /> cojDaat co_ PAYMENT <br /> RECEIVED <br /> Phone A PhonQ 9 <br /> tleh•smrlenvisionVepoRs15021.rF 9 3010 �0 � - TEB-2 2_-2011 <br /> SAN JOAQUI'N COUNTY <br /> �- HEALTH❑EPARTfCENI <br />