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I <br /> Dale ret 6/2'7/2013 10:45:53AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/27/2013 <br /> Record Selection Criteria. Facility to FA0002925 <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 10 OW0002184 New Owner ID <br /> Owner Name BELL, CHRISTINE LIVING TRUST <br /> Owner DBA MORADA MOBILE HOME PARK <br /> Owner Address 4833 FULL MOON DR u�� <br /> EL SOBRANTE, CA 94803 <br /> Home Phone 510-390-0867 <br /> Work/Business Phone Not Specified <br /> Mailing Address 489 7r�� <br /> FI SORRAw TE n CA r11 Mt D(,F'Tp Wt.) A 4y`f{pt— U `{b9 <br /> Care of I <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0002925 <br /> Facility Name MORADA MOBILE HOME PARK <br /> Location 9454 N HWY 99 <br /> STOCKTON, CA 95212 <br /> Phone <br /> Mailing Address 5 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 08515006 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DAVID BELL <br /> Title <br /> Day Phone 510-390-0867 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002486 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MORADA MOBILE HOME PARK (ClrcleOne) <br /> Account Balance as of 6/27/2013: $525.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4242-WASTE WATER TX PLANT PR0420079 EE0005944-MICHAEL ESCOTTO Active Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,aclinowtedge that all site,angor project specific,PHSIEHD 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 ender Standards and State ander <br /> Federal Laws. S, /� �J 2 <br /> APPLICANT'S SIGNATURE: I � � `'n L'L' (`12 � 1 A'VI t> 1k LC.- Date / -� / 1J <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 Receive by <br /> REHS: Date_/ I Account out: Date_/ .1'7/ /,3 <br /> COMMENTS: n <br /> 1/JG L�jtJ/ SS OAL)L-y <br />