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Date run 4/6/2015 3:29:14PM SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT <br /> Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4!612015 <br /> Record Selection Criteria: Facility ID FA0016559 <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 SSNI Fed Tax ID <br /> Owner IID OW0013414 New Owner ID <br /> Owner Name MARK FETSCH <br /> Owner DBA STAN FETSCH & SON <br /> Owner Address 1843 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209_463-8310 <br /> Mailing Address 1843 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0016559 10185199 <br /> Facility Name STAN FETSCH & SON <br /> Location 1843 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-466-3663 x0 <br /> Mailing Address 1843 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Care of Mark Fetsch <br /> Location Code Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 15307033 Eli <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029196 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name MARK FETSCH (Circle one) <br /> Account Balance as of 41612015: $0.00 <br /> (circle One) <br /> Transfer to Activellnactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PRO524656 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONSIYR PRO538514 EE0000027-CINDY VO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531552 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator cr agent of same,acknowledge that all site,and+or project specific,PHSILHD 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 State andlor <br /> Federal laws. <br /> APPLICANT'S SIGNATURE: Date 1 ! <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date ! 1 Account out: Date ! 1 <br /> COMMENTS: <br />