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Date run 12/24/2012 2:24:OOP SAN Jl WIN COUNTY ENVIRONMENTAL HES -4 DEPARTMENT Report#5021 <br /> Run by yoakum Facility Information as of 12/24/2012 Pagel <br /> Record Selection Criteria: Facility ID FA0021591 <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 OW0017752 New Owner ID <br /> Owner Name SAN JOAQUIN VALLEY ASSOCIATES <br /> Owner DBA <br /> Owner Address 24012 CALLE DE LA PLATA#460 <br /> LAGUNA HILLS, CA 92653 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 24012 CALLE DE LA PLATA#460 <br /> LAGUNA HILLS, CA 92653 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0021591 <br /> Facility Name SAN JOAQUIN VALLEY ASSOCIATES <br /> Location 1810 S FRESNO AVE <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 1810 S FRESNO AVE <br /> STOCKTON, CA 95210 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 16382065 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 AR0039110 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SAN JOAQUIN VALLEY ASSOCIATES (Circle One) <br /> Account Balance as of 12/24/2012: $-750.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0537516 EE0001699-JOHNNY YOAKUM Active Y N A I 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 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 andlor Standards and State and/or <br /> 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 <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />