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f <br /> Dale run 11/2/2010 1 : 15:04PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repoda5021 <br /> Run by M <br /> Facility Information as of 11 /2/201 . Pagel <br /> Record Selection Criteria: Facility ID FA0019025 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION SSN / Fed Tax ID <br /> Owner ID OW0015662 New Owner ID <br /> Owner Name STOCKTON HOUSING INVESTORS LP <br /> Owner DBA <br /> Owner Address 2010 MAIN ST 1250 <br /> IRVINE, CA 92614 <br /> Home Phone 949-222-9119 <br /> Work/Business Phone Not Specified <br /> Mailing Address 2010 MAIN ST <br /> IRVINE, CA 92614 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019025 <br /> Facility Name STOCKTON HOUSING INVESTORS <br /> Location 2154 S EL DORADO ST <br /> STOCKTON , CA 95206 <br /> Phone <br /> Mailing Address 2010 MAIN ST #1250 <br /> IRVINE, CA 92014 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 001 - VILLAPUDUA Fax <br /> APN 16705021 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 AR0033864 New Account ID: : <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ROKEN EERING SERVICES (arae one) <br /> Account Balance as of 11 /2/2010: ($0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status ,jaz,V Ylf New Owner? Delete <br /> 2950 - ENVIRON ASSESS PRO528097 EE0006219 - LORI DUNCAN A&rve Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andlor project specific, PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations vAll be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or 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 I 1 <br /> Payment T e Check Number Received by <br /> REHS: Z&A - -v>zf= Date /j / 2- / / O Account out: Date <br /> COMMENTS' ^ yn <br /> V/ <br /> \\eh-env\envision\reports\5021 .rpt <br />