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Report SW21 <br /> Date run 3119/2015 2:57:29PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Pagel <br /> Run by Facility Information as of 3/19/2015 <br /> Record Selection Wane: Faulity ID FA0021244 <br /> Make ehangealeorrections 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 OW0017513 New Owner lD <br /> Owner Name J & R ENVIRONMENTAL <br /> Owner DBA <br /> Owner Address 27226 VIA INDUSTRIA <br /> TEMECULA, CA 95290-3751 <br /> Home Phone 951-567-3805 <br /> Work/BusinessPhone 951-567-3805 <br /> Mailing Address 43422 Calle De Velardo <br /> TEMECULA, CA 92592 <br /> Care of MILES, ADAM H <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021244 10187789 <br /> Facility Name J & R ENVIRONMENTAL <br /> Location 7557 W CARMELO AVE <br /> Tracy, CA 95304 <br /> Phone 951-567-3805 x <br /> Mailing Address 43422 Calle De Velardo <br /> TEMECULA, CA 92592 <br /> Care of MILES, ADAM H <br /> Location Code Alt Phone <br /> BOS District 005-ELLIOTT, BOB Fax <br /> APN 25014014 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 AR0038395 New Account ID: <br /> Maillnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name J & R NTAL (time one) <br /> Account Balance as of 3/19/20 $758.00 ` 1 <br /> (CiOne) <br /> Transfer Activene/Inadve <br /> Program/Element and Description Record ID Employee 10 and Name Status New Owner' Delete <br /> 1921 -HMBP-Regular-Primary Location PRO537276 EE0002474-MICHAEL PARISSI Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PRO536999 EE0002646-THUY TRAN Active Y N A D <br /> 2239-REMOTE WASTE CONSOLIDATION SITE PRO538412 EE0002646-THUY TRAN Active,l Y N A D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0538133 EE0002620-ALFONSO ARAMBULA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO537000 EE0002646-THUY TRAN Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. 1,the undersigned owner,operator ar agent of same,acknowledge Nat all site,andror project specific,PHSIEHD hourly charges assou ted with this fsuliy <br /> or activity will bo billed to the party iderfified as the OWNER on this forth. I also oertly that all operations will be performed in accordance with all applicable Ordinance Codes enaor Standards and State ardor. <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: �I P_6A_51C- rIQ..V Date <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 , C Received y <br /> REHS: Date /�/� Account out: Date 3 / 2 / <br /> COMMENTS: /� <br /> S� t tai <br /> 1 ru/o r c� <br />