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Date run 3/27/2009 1:51:012PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Facility Information as of 3/27/2009 Pagel <br /> Record Selection Criteria: Facility ID FA0015883 <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 ID OW0012804 New Owner ID <br /> Owner Name GEORGE GARCIA <br /> Owner DBA AD FORCE PRIVATE SECURITY <br /> Owner Address 1625 N REPORT AVE <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-462-8420 <br /> Mailing Address PO BOX 55331 <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015883 <br /> Facility Name AD FORCE PRIVATE SECURITY <br /> Location 1625 N REPORT AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-462-8420 x0 <br /> Mailing Address PO BOX 55331 <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 14316037 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GEORGE GARCIA <br /> Title <br /> Day Phone 209-462-8428 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027639 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner ! Facility / Account <br /> Account Name AD FORCE PRIVATE SECURITY (Circle One) <br /> Account Balance as of 3/27/2009: $0.00 <br /> (Circle One) <br /> Transfer to Active/Ince <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0527857 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0523504 Active Y N A I 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 <br /> facility or adwity,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 Ordinace Codes and/or Standards and <br /> State andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: $20.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: $372.00= Amount Paid Date / I <br /> Payment Type Check Number Received by <br /> REHS: Date Account out: Date ,tel /.3a /40el <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />