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Date run 2J22/2008 2;.59:54Ph1 SAN JO UIN COUNTY ENVIRONMENTAL HEAT 'I DEPARTMENT Report#5021 <br /> Run by f 11111110 i <br /> Facility Information as of 2122120 N--- <br /> Paget <br /> Record Selection Criteria: Facility 1D FA0014254 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011307 New Owner ID <br /> Owner Name EQUILUZ, JORGE & ESTELA <br /> Owner DBA DELTA VALLEY SANITATION SVC <br /> Owner Address 7125 E UYEDA RD <br /> STOCKTON, CA 95215 <br /> Home Phone 209-931-8436 <br /> Work/Business Phone 209-601-9430 <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 D b8Lf1-f 14 20 <br /> Phone 209-931-8900 <br /> Mailing Address 7125 E UYEDA RD <br /> STOCKTON, CA 95215 <br /> Care of DELTA VALLEY SANITATION SVC <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024196 New Account ID.,: <br /> Mail Invoices to Facility r Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name DELTA VALLEY SANITATION SVC (Circle One) <br /> Account Balance as of 212212008: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PR0519050 EE0007379-AMANDA BOERTIEN Inactive Y N A I D <br /> 4244-PUMPER TRUCK PR0526910 EE0007379-AMANDA BOERTIEN Active Y N A I D <br /> �—)4246-PUMPER YARD PR0526920 EE0007379-AMANDA BOERTIEN Active Y N A I D <br /> 4255-CHEMICAL TOILETS PR0526921 EE0007379-AMANDA BOERTIEN Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operatoor agent of same,acknowledge that all site,and/or 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 rti that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date Z12Z l <br /> Program Records to be TRANSFERED: 1 .0 (D )Amount Paid Date I I <br /> Water System to be TRANSFERED: *$372.00= Amount Paid `{t�Date —21 "7-'2—I� <br /> Payment Type 42-�\5kk Check Number Received by 7�� <br /> REHS: --o 6)3 Z Date 127-1 Account out: Date <br /> COMMENTS: T, � PAYMENT <br /> RECEIVED <br /> FEB 2 2 200$ <br /> � <br /> fN"JI� -ro lW � 5-7e SANJOAQUINC COUNTY <br /> FiONMENHEALTH DEPARTMENT <br /> 11phs-ehsgl-ntlappslenvisionslreports15021.rpt <br />