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Date run 9/29/2015 8:57:56Af\ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9129/2015 <br /> Record Selection Criteria: Facility ID FA0023127 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN/Fed Tax ID : <br /> Owner ID OW0007738 Case Number: H05285 New Owner ID <br /> Owner Name Peloria Paradise Point LLC <br /> Owner DBA <br /> Owner Address 8095 RIO BLANCO RD <br /> STOCKTON, CA 95219 <br /> Home Phone 209-602-1020 <br /> Work/Business Phone 209-952-1000 <br /> Mailing Address 8095 RIO BLANCO RD <br /> STOCKTON, CA 95219 <br /> Care of PELORIA PARADISE POINT LLC <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0023127 10182851 <br /> Facility Name PARADISE POINT MARINA <br /> Location 8095 RIO BLANCO RD <br /> STOCKTON, CA 95219 <br /> Phone 209-952-1000 x <br /> Mailing Address 8095 RIO BLANCO RD <br /> STOCKTON, CA 95219 <br /> Care of Paradise Point Marina <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 06605052 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0042488 New Account ID: <br /> Mail lnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name PARADISE POINT MARINA (Circle One) <br /> Account Balance as of 9/29/2015: $0.00 <br /> (Circle One) <br /> Transfer to ActiMinactve <br /> ProgranvElement and Description Record ID Employee ID and Name Status New Omer? Delete <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,an&or protect specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party idercified as the OWNER on this form I also cemly that all operations will be performed in accordance with all applicable Ordinance Codes anryor Standards and State andror <br /> Federal Lawn <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 by <br /> EHD Staff: Date_/ / Account out: Date <br /> COMMENTS: Invoice#: <br />