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Date run 11/27/2017 9:15:32A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Reportd5021 <br /> Run by A Paget <br /> Facility Information as of 11/27/2017 <br /> Record Selection Criteria: Facility ID FA0017288 <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 OW0014129 New Owner ID <br /> Owner Name WILLIAM SARALE <br /> Owner DBA WILLIAM SARALE <br /> Owner Address 14600 E EIGHT MILE RD <br /> LINDEN, CA 95236 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-470-0747 <br /> Mailing Address PO BOX 7960 <br /> STOCKTON, CA 95267 V N <br /> 1 <br /> Care of O <br /> FACILITYFacility IIDFOER AIiDFA0017288 10186217 ��Q�R�\ <br /> Facility Name WILLIAM SARALE <br /> Location 14600 E EIGHT MILE RD <br /> LINDEN, CA 95236 <br /> Phone 209-470-0747 x <br /> Mailing Address PO BOX 7960 <br /> STOCKTON, CA 95267 <br /> Care of William Sarale <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 09101008 �^ EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title 0 <br /> Day Phone ^� <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION'! J(. r <br /> Account ID AR0030170 // "oC1 NewAccount ID: <br /> Mail Invoices to Account .(� !l Mail Invoices to: Owner / Facility / Account <br /> Account Name WILLIAM SARALE \IQ X� (Circle One) <br /> Account Balance as of 11/27/2017: $0.00 / <br /> (� '( `'!✓X (Circle One) <br /> �/ Transfer to Active/Inactve <br /> PrograMElement and Description Re d 10 Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO525473 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0530384 EE0001421 -STACY RIVERA Active Y N A"FIj D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO630383 EE9999998-ONE VACANTI Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531890 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ands project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as Ne OWNER an this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andror Standards and State anNor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date �" /Z ` <br /> Program Records to be TRANSFERED: _*$25.00=_ Amount Paid Date / � �/ <br /> Water System to be TRANSFERED: Amount Paid l.�'--Lf r ' <br /> Payment Type Check Number Received by v1(..dL. e l�N• <br /> EHD Staff: Date_LL/_L2_/ / r2 Account out: Date / / <br /> COMMENTS: 7� <br /> Invoi <br /> 22�-- <br />