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Daterun 8/5/2013 9:13:54AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> = Facility Information as of 8/5/2013 <br /> Record Selection Criteria: Facility ID FA0000107 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) — <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION D„ I� $O SSN/Fed Tax ID : �— <br /> Owner ID XS <br /> l/(/ 1 W New Owner ID <br /> Owner Name ST WEST BANK <br /> Owner DBA FRENCH CAMP APARTMENTS <br /> Owner Address 9300 FLAIR DR <br /> EL MONTE, CA 91731 ti^;n kTcr� L AC <br /> Home Phone 209-470-6221 <br /> Work/Business Phone Not Specified <br /> Mailing Address 9300 FLAIR DR <br /> EL MONTE, CA 91731C? n l �f5a6 "% <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FAD000107 <br /> Facility Name FRENCH CAMP APARTMENTS <br /> Location 7501 S ELDORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-470-6221 <br /> Mailing Address 2423 W MARCH LN STE 202 <br /> STOCKTON, CA 95207 , C `e� <br /> Care of BLR COMMERCIAL-PETER F MARTIN <br /> Location Code 99 - UNINCORPORATED A Alt Phone toff /y/ y <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 19316052 EMail: N,, V, 11 I her, <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MANI, SUBAR , <br /> Title <br /> Day Phone 510-792-2377 , ��1 1C1 1"! <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000106 New Account ID: <br /> Matinvoicesto Facility B-IR ces to: Owner / Facility / Account <br /> Account Name FRENCH CAMP APARTMENTS _ (Circle one) <br /> Account Balance as of 8/5/2013: $0.00 <br /> (Circle One) <br /> Transfer to Actwo(Inactve <br /> Progran✓Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4242-WASTE WATER TX PLANT PR0420069 EE0004045-TED TASIOPOULOS Active � N a) I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Ina undersigned owner,operator or agent of same.acknowledge that all site,andor project specific,PHSIEHD hourly charges assoaded with this facility <br /> or activity will be billed to the party idenlRed as Na OWNER on this fam I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws. <br /> v <br /> APPLICANTS SIGNATURE: Date cp. l Jr -/-')0 1-3 <br /> Program Records to be TRANSF .$25.00= Amount Paid,, Date <br /> Water System to TRANSFE ED: Amount Paid Date <br /> Payment a Check Number 11AEL� Received b <br /> REHS 77� 6>.r.�>s Datef�/ S ! /j Accountout: Datel <br /> COMMENTS: �� RECEIVED <br /> A, � G /H VvI.1e5 <br /> AUG 0 5 2013 <br /> �A'5�1 SAN JOAQUIN COUNTY <br /> ENVIROMENTAL <br /> J pJ/ HEALTH DEPARTMENT <br />