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Date run 12/31/2012 10:22:32/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/31/2012 <br /> Record Selection Criteria: Facility 10 FA0014254 <br /> Make changes/corrections in RED ink. <br /> INFORMATION <br /> FILE OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <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/BusinessPhone 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 10842 S HARLAN RD <br /> FRENCH CAMP, CA 95231 <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 99 - UNINCORPORATED P Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 19333028 Entail: <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 /> Account ID AR0024196 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name DELTA VALLEY SANITATION SVC (Circle One) <br /> Account Balance as of 12/31/2012: $0.00 <br /> (Circle One) <br /> Transfer to Activellnadve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PR0519050 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 PR0526920 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 antl COMPLIANCE ACKNOWLEDGEMENT: I,Ne undersigned owner,operator or agent of same,acknowledge that all site,ander project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as Ne OWNER on this form I also cartify that all operations will be performed in accordance with all applicable Ordinance Codes andior Standards and State andior <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date if <br /> Payment T e Check Number Received by <br /> RENS: —7�— � aG� Date - �a—I t I I /a Account out: Date / 7 <br /> COMMENTS: <br /> j//eases 0/ c4ee -1v Ic15 �1a C - l\ / <br /> / A�ausd <br />