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Date run 3/25/2009 10:37:34Ai1 SAN JCS JUIN COUNT ENVIRONMENTAL HE�,�iA DEPARTMENT R� 21 <br /> Run by 4006 i <br /> Facility Information as of 3/25/2009 Pagel <br /> Record Selection Criteria: Facility ID FA0014254 <br /> i <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN!Fed Tax ID <br /> Owner ID OW 0011307 New Owner ID <br /> Owner Name EQUILUZ, JORGE & ESTELA <br /> Owner DSA DELTA VALLEY SANITATION SVC <br /> Owner Address 7125 E UYEDA RD <br /> STOCKTON, CA 95215 <br /> Home Phone 209,931-8438 <br /> Work/Business Phone 209-601-9430 j <br /> Mailing Address 7125 E UYEDA RD <br /> STOCKTON, CA 95215 <br /> Care of DELTA VALLEY SANITATION SVC <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014254 <br />{ Facility Name DELTA VALLEY SANITATION SVC <br />+' Location 10842 S HARLAN RD j <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-931-8900 <br /> Mailing Address 7125 E UYEDA RD k <br /> STOCKTON, CA 95215 , <br /> Care of DELTA VALLEY SANITATION SVC <br /> Location Code 99- UNINCORPORATED E Alt Phone <br /> BOS District 001 - GUTIERREZ, STEVE Fax <br /> APN 19333028 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DELTA VALLEY SANITATION.SVC <br /> Title <br /> Day Phone 209-931-8900 <br /> Night Phone <br />+ ACCOUNTS RECEIVABLE FILE INFORMATION <br /> f <br /> Account ID AR0024196 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility ! Account <br /> - Account Name DELTA VALLEY SANITATION SVC (CirdeOne) <br /> Account Balance as of 312512009: $0.00 <br /> (Circle One) <br /> Transfer to Ac ive/inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PRO519050 EE0005944-MICHAEL ESCOTTO Inactive Y N A I D <br /> 4244-PUMPER TRUCK PRO526910 EE0005944-MICHAEL ESCOTTO Active Y N A I D <br /> 4246-PUMPER YARD PRO526920 EE0005944-MICHAEL ESCOTTO Active Y N A I D <br /> 4255-CHEMICAL TOILETS PR0526921 EE0005944-MICHAEL ESCOTTO Active Y N A I D ' <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknaNedge that all site,and/or project specific,PHSIEHD hanty 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 will be performed in accordance with all applicable Ordinace Godes and/or Standards and <br /> Slate and/or Federal Laws.Yr i <br /> I <br /> i <br /> APPLICANT'S SIGNATURE: Z5 Date � � / 1 0 2 <br /> Program Records to be TRANSFERED: -$20.00= Amount Paid Date ! ! <br /> Water System to be TRANSFERED: '$372.00= Amount Paid `l -Date 3w 13 I <br /> I Payment Type Check Number Received by (�- <br /> REHS: Date ! 1 Account out: Date 3 ! 1YMENT <br /> COMMENTS: DECEIVED <br /> MAR 2 5 2099 <br /> SAN JQAQUIN COUNTY <br /> ENVIRONMENTAL <br />! 11eh-envlsnvisionlreports15021.rpt HEALTH DEPARTMENT <br />