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Date run 7/1/2020 11:42:24AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/1/2020 <br /> Record Selection Criteria: Facility ID FA0012338 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 75 SSN/Fed Tax ID <br /> Owner ID OW0001176 New Owner ID <br /> Owner Name CITY OF STOCKTON <br /> Owner DBA <br /> Owner Address 425 N ELDORADO ST <br /> STOCKTON, CA 95202 <br /> Work/Business Phone 209-937-8341 <br /> Alternative Phone 209-937-8212 <br /> Mailing Address 425 N EL DORADO ST <br /> Stockton, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0012338 <br /> Facility Name ROUGH & READY ISLAND <br /> Location 305 W FYFFE AVE <br /> STOCKTON, CA 95202 <br /> Phone <br /> Mailing Address ROUGH & READY ISLAND <br /> STOCKTON, CA 95202 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, MIGUEL Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name RANDALL, DAVID <br /> Title ENVIRONMENTAL ENGINEER <br /> Day Phone 714-431-4150 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020159 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CITYTON (Circle One) <br /> Account Balance as of 7/1/2020 $-234.002 (, <br /> X /LPaJ(P.r <br /> C�a a.( ` 'r t' <br /> �/ Q (Circle One) <br /> 1 7 Transfer to Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0515765 EE0007479-RON ROWE Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD 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 and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: <br /> Date �/ 1 / Zt <br /> Program Records to be TRANSFE D: `$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> Invoice#: <br />