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Date run 10/25/2017 2:47:02P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/25/2017 <br /> Record Selection Criteria: Facility ID FA0019932 <br /> Make changestcorrections in RED ink. 7 <br /> INFORMATION CHANGE(date) L �s / <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0016355 New Owner ID <br /> Owner Name PJ's Rebar Inc <br /> Owner DBA <br /> OwnerAddress 45055 FREMONT BLVD <br /> FREMONT, CA 94538-6318 <br /> Home Phone Not Specified <br /> Work/Business Phone 510-743-5300 <br /> Mailing Address 45055 Fremont Blvd <br /> Fremont, CA 94538-6318 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019932 10187435 <br /> Facility Name PJ's Rebar Inc <br /> Location 474SAURORA ST <br /> STOCKTON, CA 95203 <br /> Phone 510-743-5300 x <br /> Mailing Address 474 SAURORA ST [� 4 f /I <br /> U <br /> STOCKTON, CA 95203 <br /> care of PJ's Rebar Inc <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0035511 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name PXSRebar Inc ojjjj^^^^ (Circle One) <br /> Account Balance as of 10/25/2017: $ .00 <br /> 1 ` J (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO530776 EE0009817-ROBERT LOPEZ Iv Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO541745 EE0000021 -LOR XIONG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO532048 Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andor 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 andor Standards and State andor <br /> Federal Laws <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to b TRANSFERED: Amount Paid Date <br /> Payment Ty a Check Number Received by <br /> EHD Staff: Date 0 /�/ -z7 Account out: DateIr 1 ;2-7 11-7 <br /> COMMENTS: <br /> Invoice#: <br />