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Report#5021 <br /> ERecord <br /> 6/24/2020 8:58:OOAA SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Pagel <br /> Facility Information as of 6/24/2020 <br /> Selection Cr feria: Facility ID FA0000107 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: SSN/Fed Tax ID <br /> Owner ID OW0018018 New Owner ID <br /> Owner Name HALL, KIM <br /> Owner DBA FRENCH CAMP APARTMENTS <br /> Owner Address 523 <br /> 7 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 209-923-1919 0 <br /> Mailing Addres 2 <br /> Care of HALL, KIM <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0000107 <br /> Facility Name FRENCH CAMP APARTMENTS <br /> Location 7501 S ELDORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-470-6221 f� <br /> Mailing Address lox 31D <br /> �,er�c�n CAMP, Pa. g s 2 3 <br /> Care of <br /> Location Code 99-UNINCORPORATED A Alt Phone <br /> BOS District 001 -VILLAPUDUA, MIGUEL Fax <br /> APN 19316052 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name HALL, KIM <br /> Title OWNER <br /> Day Phone 209-923-1919 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000106 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Faciiity / Account <br /> Account Name FRENCH CAMP APARTMENTS C-r*e One) <br /> Account Balance as of 6/24/2020: $0.00 <br /> (Circle One) <br /> Program/Element and Description Record ID Employee ID and Name status o Active+M+er? Dellete ete ve <br /> New O <br /> 4242-WASTE WATER TX PLANT PR0420069 EE0000034-NASEEM AHMED Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific.PHSIEHD hourly charges associated with this facility <br /> 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 Ordinance Codes andror Standards and State andror <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / r <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> Ir1V01Ce#: <br />