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Date run 8/19/2015 1:56:30PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 8/19/2015 <br />Record Selection Criteria: Facility ID FA0023083 <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 <br />SSN /Fed Tax ID <br />Owner ID OW0021167 <br />New Owner ID <br />Owner Name Ron Mozingo <br />Owner DBA <br />Owner Address <br />Home Phone Not Specified <br />Work/Business Phone 925-337-1733 <br />Mailing Address 1860 URBANA WAY <br />Sacramento, CA 95833 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0023083 10635682 <br />Facility Name S n %RYhC'J I`��✓t &.Oer(- <br />Location 1627 INDUSTRIAL DR STE C <br />Stockton, CA 95206 <br />Phone 209-467-8999 x <br />Mailing Address 1627 Industrial Dr Ste C <br />Stockton, CA 95206 <br />Care of American Power Systems, LLC <br />Location Code <br />Alt Phone <br />BOS District <br />Fax <br />APN <br />EMail : <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0042386 <br />New Account ID: <br />Mail Invoices to Account <br />Mail Invoices to: Owner / Facility / Account <br />Account Name Ben Gillihan <br />(Circle One) <br />Account Balance as of 8/19/2015: $0.00 <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-Regular-Primary Location PRO540389 EE0009817 - ROBERT LOPEZ Active Y N A I D <br />2220 - SM HW GEN <5 TONS/YR PR0540388 EE0001421 - STACY RIVERA Active Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/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 Slate and/or <br />Federal Laws. <br />APPLICANTS SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: <br />COMMENTS:I /� fw ^ <br />P)/., � ` �I GY�v�I t Cit �S <br />Date <br />$25.00 = Amount Paid Date <br />Amount Paid Date <br />Date <br />Received <br />Account out: &57 Date 1 <br />Invoice #: <br />Qom,,, r <br />I - f/� i , <br />heLk'- <br />