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Date run 3/3/2014 8:47:30AM SAN JOIN COUNTY ENVIRONMENTAL HEALJWEPARTMENT Report95021 <br /> Run by Paget <br /> Facility Infofmation as of 3/312014 <br /> Record Selection Criteria: Facility ID FA0010940 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008940 Case Number: H09019 New Owner ID <br /> Owner Name BONILLA, JUAN GILBERTO <br /> Owner DBA ALMAZAN WELDING SERVICES <br /> Owner Address 1691 LEVER BLVD <br /> STOCKTON. CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-942-4280 <br /> Mailing Address 1691 LEVER BLVD <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0010940 10,183,953 <br /> Facility Name ALMAZAN WELDING SERVICES <br /> Location 1566 S STOCKTON ST <br /> STOCKTON, CA 95206 <br /> Phone 209-464-2336 x0 <br /> Mailing Address 1691 LEVER BLVD <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code Alt Phone <br /> BOIS District Fax <br /> APN 16323028 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017940 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name BONILLA, JUAN GILBERTO (Circle One) <br /> Account Balance as of 3/3/2014: $305.00 <br /> (Circle One) <br /> Transferto Active/Inacive <br /> Program/Element and Description Record ID Employee 10 and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520563 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513228 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO610940 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531723 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. ],the undersigned owner,operator or agent of same,acknowledge that all site,and/or 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 cartifythat all operations will be performed in accordancewdr,all applicable Ordinance Codes andor Standards and State ands <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 /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />