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Date run 12/8/2020 1:11:50PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/8/2020 <br /> Record Selection Criteria: Facility ID FA0025541 <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: 1 SSN/Fed Tax ID <br /> Owner ID OW0024201 New Owner ID <br /> Owner Name HOWARD, ARTHUR <br /> Owner DBA <br /> Owner Address 3343 S FAIRMONT AVE <br /> STOCKTON, CA 95206 <br /> Work/Business Phone Not Specified <br /> Alternative Phone Not Specified <br /> Mailing Address 3343 S FAIRMONT AVE <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION APN 16919022 <br /> Facility ID/CERS ID FA0025541 <br /> Facility Name HOWARD, ARTHUR <br /> Location 1576/ 1562 E SIXTH <br /> STOCKTON, CA 95206 <br /> Phone JA <br /> Mailing Address 3343 S FAIRMONT AVE <br /> STOCKTON, CA 95206 <br /> Care of <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0048228 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name HOWARD, ARTHUR (Circle One) <br /> Email invoice to(up to 2 emails) <br /> Email permit to(up to 2 emails) <br /> Account Balance as of 12/8/2020: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1253-Lead Abatement Case PR0544927 EE0002089-OMRAN SOOD Active Y N A 0 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD 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 and/or Standards and State andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received b <br /> EHD Staff: /I�9„nQg Date�/ D c4 l 26 Account out: / Date 7 ;2 / <br /> COMMENTS: GLOSS LW -&f, <br /> Invoice#: <br />