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Date run 10/22/2021 3:36:48F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/22/2021 <br /> Record Selection Criteria: Facility ID FA0026077 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0024729 New Owner ID <br /> Owner Name GRINDSTONE JOE ASSOCIATION <br /> Owner DBA GRINDSTONE JOE ASSOCIATION <br /> OwnerAddress 1029 N COUNTRY CLUB BLVD <br /> STOCKTON, CA 95204 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 209-464-5986 <br /> Mailing Address 1029 N COUNTRY CLUB BLVD <br /> STOCKTON, CA 95204 <br /> Care of <br /> FACILITY FILE INFORMATION APN <br /> Facility ID/CERS ID FA0026077 <br /> Facility Name GRINDSTONE JOE ASSOCIATION <br /> Location 13550 W HWY 12 <br /> LODI, CA 95242 <br /> Phone 209-464-5986 <br /> Mailing Address 1029 N COUNTRY CLUB BLVD <br /> STOCKTON, CA 95204 <br /> Care of <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0049404 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name GRINDSTONE JOE ASSOCIATION (Circle <br /> Email invoice to(up to 2 emails) scott@cogenia.com; gkamilos@kamilos.com _ <br /> Email permit to(up to 2 emails) scott@cogenia.com; gkamilos@kamilos.com _ <br /> Account Balance as of 10/22/2021: $-493.00 �S )ne) <br /> Program/Element and Description Record ID Employee ID and Name ctve�`� <br /> 4232-ALT/ENG OWTS-ANNUAL PERMIT-Full Permit PR0546111 EE0000034-NASt D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that, !J� V <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 ac .t Z <br /> Federal Laws. ✓ <br /> APPLICANT'S SIGNATURE: P <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid 1'p <br /> Water System to be TRANSFERED: Amount Paid <br /> Payment Type Check Number R <br /> EHD Staff: Date / / Account out: <br /> COMMENTS: <br />