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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 />R'�v\riC'- <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0018187 <br />Owner Name <br />Facility Name <br />Owner DBA <br />2Plum E;yi, <br />Owner Address <br />5 <br />Work/Business Phone <br />K-E—RMAN, GA 98688 <br />559-846-9607 <br />Alternative Phone <br />Not Specified <br />Mailing Address <br />559-846-9607 <br />KERMA r__ 6 93830 <br />Care of <br />K�i - ^'t�r,'�l�M J <br />FACILITY FILE INFORMATION APN <br />Make chan rectio <br />INFORIRJdATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Ownr ID <br />C�'of �etn Co <br />�—la- <br />�.��-�-�-+- <br />t!M <br />Facility ID / CERS ID <br />FA0022106 <br />Facility Name <br />C <br />2Plum E;yi, <br />Location <br />17771 W GETTYSBURG <br />KERMAN, CA 93630 <br />Phone <br />559-846-9607 <br />Mailing Address <br />5- -ME)BeC <br />L <br />K r —r- <br />A <br />Care of <br />K <br />J QS p �- -T—, n i ciA� <br />C2 znes US <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />�r ��� <br />cv <br />Contact Name <br />W166G/411A-d-KI€ F <br />Pa <br />2S b <br />Title <br />OWNER <br />Day Phone <br />559-846-9607 <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID <br />AR0040304 <br />New Account ID: <br />Mail Invoices to <br />Facility <br />Mail Invoices to: Owner / Facility / Account <br />Account Name <br />A (Circle One) <br />Email invoice to (up to 2 emails) <br />Email permit to (up to 2 emails) <br />�, <br />S <br />Account Balance as of 5/4/202: <br />$368.00 /i T IaF0 f,)6 <br />(Circle One) <br />Transfer to Activellnactve <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 WONG 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 andlor Standards and Slate andlor <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 by <br />EHD Staff: Date / / Account out: Date <br />COMMENTS: <br />IDVOICe #: <br />a It lfi S Q. � � OVl <br />w k►C be- cry. <br />o--;4 412-1 /2- 2-� <br /><eqa4-r'-� " r, L <br />IT dif P�'C— k>l' � I <br />"k"�'ks� <br />-i�"kave'- <br />