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Date run 1/30/2015 8:41:53AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 1/30/2015 Pagel <br /> Recem!Select.Catena: Facility ID FAD017437 <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: 3 SSN/Fed Tax ID <br /> Owner ID OW0000486 New Owner ID <br /> Owner Name FERRERO, FREDERICK D <br /> Owner DBA FREDERICK D FERRERO <br /> Owner Address 4353 W WOODBRIDGE RD <br /> LODI, CA 95242 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-369-9652 <br /> Mailing Address 4353 W WOODBRIDGE RD <br /> LODI, CA 95242 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017437 10186451 <br /> Facility Name FREDERICK D FERRERO <br /> Location 4353 W WOODBRIDGE RD <br /> LODI, CA 95242 <br /> Phone 209-369-9652 x <br /> Mailing Address 4353 W WOODBRIDGE RD <br /> LODI, CA 95242 <br /> Care of FREDERICK D FERRERO <br /> Location Code 99-UNINCORPORATED P Aft Phone <br /> Bos District 004-VOGEL, KEN Fax <br /> APN EMail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION �� <br /> Contact Name _ �Ir�U /lAL_-f <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030319 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name FERRERO, FREDERICK D (Circle one) <br /> Account Balance as of 1/30/2015: $107.00 <br /> (Circle One) <br /> P,PgranniEwmant to Agrvdlname <br /> and Description Record ID Employee ID and Name Status New Ownal! Delete <br /> 1958-HM-Fane Operations PRO525622 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2221-USED OIL ONLY-<5 TONS/YR PRO538615 EE0001422-ARIS VELOSO Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0529835 EE0000753-WILLY NG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532451 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent or same,acknowledge that all site,ander project specific.PHSIEHD hourly bnarges associated with ms facility or; <br /> be filled to me party idsnuned as the OWNER on this torn I also canny that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ardor Federal Laws. <br /> APPLICANTS SIGNATURE: Dale <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 b <br /> RENS: Date / Account out: Date_/ O //S ' <br /> COMMENTS: <br />