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Date run 10/15/2018 8:45:09A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Page <br /> Facility Information as of 10/15/2018 <br /> Record Selection Criteria: Facility ID FA0009208 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) o <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0007208 Case Number: H02050 New owner ID <br /> Owner Name BPS <br /> Owner DBA BPS-STOCKTON <br /> OwnerAddress PO BOX 639 <br /> BAKERSFIELD, CA 933020639 <br /> Home Phone Not Specified <br /> Work/Business Phone 661-589-9141 <br /> Mailing Address PO BOX 639 <br /> BAKERSFIELD, CA 933020639 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009208 <br /> Facility Name BPS-STOCKTON <br /> Location 2245 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-337-0055 x0 <br /> Mailing Address PO BOX 639 <br /> BAKERSFIELD, CA 933020639 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, MIGUEL Fax <br /> APN 16336017 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MARSHALL BOBSON <br /> Title <br /> Day Phone 209-337-0055 x0 <br /> Night Phone 209-942-4346 Cell <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016208 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name BPS-STOCKTV1 1 (Circle One) <br /> Account Balance as of 10/15/2018. $ 00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0519461 EE0009817-ROBERT LOPEZ Active Y N A l',' D <br /> 2220-SM HW GEN <5 TONS/YR PR0513700 EE0002646-THUY TRAN Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511496 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509208 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ancl/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 andror <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: Dated// / Account out: L45 Date <br /> COMMENTS: <br /> Invoice#: <br />