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Date run 5/4/2022 1:02:16PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 5/4/2022 <br />Record Selection Criteria: Facility ID FA0022106 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0018187 <br />Owner Name <br />%Ti�T <br />Owner DBA <br />Aes �L' <br />Owner Address <br />5 <br />I�E—RMAN, <br />Work/Business Phone <br />GA 93680 <br />559-846-9607 <br />Make chain rectio in Rr:n ink <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Own r ID <br />G -to! eve a I ew L A Co <br />� S n D l' fir X13 <br />Alternative Phone Phone <br />Not Specified <br />Mailing Address <br />Aes �L' <br />K 0 <br />Care of <br />;4ucrt-G ; t^rt�v,l "M J <br />FACILITY FILE INFORMATION APN <br />Facility ID / CERS ID <br />FA0022106 <br />Facility Name <br />C <br />Q <br />Location <br />17771 W GETTYSBURG <br />KERMAN, CA 93630 <br />Phone <br />559-846-9607 <br />Mailing Address <br />-pAQq4aC <br />D1C L <br />K <br />} ✓`QS 6 CA 9%q--14 <br />Care of <br />K <br />3135 �e L. T.- P1 i dkd <br />I -Q.1 6'aD cLQ <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />WI661 ."Alm- I VIOEI`nF-F <br />Title <br />OWNER <br />Day Phone <br />559-846-9607 <br />Night Phone <br />% ` <br />�G 4S21 <br />ACCOUNTS RECEIVABLE FILE INFORMATION (, <br />New Accoun'c`t'Dr <br />Account ID <br />AR0040304 <br />Mail Invoices to <br />Facility <br />Mail Invoices to: Owner / Facility / Account <br />Account Name <br />CCr�oTr� A t rnr n car - 1. <br />A (Circle One) <br />Email invoice to (up to 2 emails) <br />yl� <br />Email permit to (up to 2 emails) <br />Account Balance as of 5/4/202:$368.00 <br />4,v6 <br />6W <br />� irLht<o <br />(Circle One) <br />—40or- 1(-/� yL" Transfer to Active/Inactve <br />Program/Element and Description <br />Record ID Employee ID and Name <br />Status New Owner? Delete <br />4244 - PUMPER TRUCK <br />PR0538252 EE0009488 - JEFFREY <br />WONG Active Y N A I D <br />BILLING and COMPLIANCEACKNOWLEDGEMENT: 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 and/or <br />Federal Laws. <br />t^ <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 ReceivA?Z� <br />EHD Staff: Date ( ! Account out: Date <br />COMMENTS: <br />Invoice #: <br />o�>n 5ai� °`r <br />sop <br />up'4- <br />1�:'rll <br />� N� ZOE, <br />4;�Po k e ver- ;b <br />