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Data run 31412014 8:58:03AM SAN J0"-0'JIN COUNTY ENVIRONMENTAL HEAL` DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/4/2014 <br /> Record Selection Criteria: Facility ID FA0016973 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNI Fed Tax ID <br /> Owner ID OW0013814 New Owner ID <br /> OwnerName EDDIE &JUDY PIAZZA <br /> Owner DBA EDDIE & JUDY PIAZZA <br /> Owner Address 1155 GILLIS RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> WorklBusiness Phone Not Specified <br /> Mailing Address 1155 GILLIS RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID!CERS ID FA0016973 10,185,703 <br /> Facility Name EDDIE &JUDY PIAZZA <br /> Location 1155 GILLIS RD <br /> STOCKTON, CA 95215 <br /> Phone 209-466-7118 x0 <br /> Mailing Address 1155 GILLIS RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code Alt Phone <br /> SOS District Fax <br /> APN 17329017 EMajl: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029855 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name EDDIE & JUDY PIAZZA (Circle One) <br /> Account Balance as of 31412014: $53.00 <br /> (Circle One) <br /> Transfer to ActivelrnacNe <br /> Program/Element and Description Record ID Employee ID aadNam Status New Owner? O� D <br /> e <br /> 1958-HM-Farm Operations PRO525158 Active Y N A <br /> 2840-AST EXEMPT FAC <1,320 GAL PR05306P EE0000763-WILLY NG Active,! Y N AD <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532� Inactive Y N A I D <br /> BILLING and COMPLSANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER cn 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 I I <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Paid Date / 1 <br /> Payment Type Check Number Received b <br /> REHS: W > P.)ghDate_�1 ! 1 - Account out: Date I l <br /> COMMENTS: 1 <br />