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FRd <br /> 8/19/2015 1:56:30Pn SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report#5021 <br /> Facility Information as of 8/19/2015 Pagel <br /> tion Criteria: Facility ID FA0023083 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner ID <br /> OW0021167 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 lD/CERS ID FA0023083 10635682 <br /> Facility Name $9101;ktaf�' i4meirl��s Po,aer S7S}em� <br /> Location 1627 INDUSTRIAL DR TE 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 Alt Phone <br /> BOB District Fax <br /> APN 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 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Ben Gillihan (Circle One) <br /> Account Balance as of 8/19/2015: $0.00 <br /> (Circle One) <br /> Program/Element and Description Record ID Employee ID and NameTransfer to Active/Inactve <br /> status New Owners 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,andor project spec,PHSrEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also carry that all operations will be performed in accordance with all applicable Ordinance Codes andror Standards and State andror <br /> Federal Laws. <br /> APPLICANTS 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 <br /> COMMENTS:EHD Staff: Date _ <br /> / /_ Account out: Date / / / /S <br /> COM <br /> n Invoice#:_ <br />