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Date run 2/14/2017 2:50:23Pk SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Run by Report05047 <br /> Facility Information as of 2/14/2017 Pagel <br /> Record Selection Crderia. Fatality ID FA 0021991 <br /> Make changesicorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 <br /> Owner ID OW0018105 SSN/Fed Tax ID <br /> New Owner ID <br /> Owner Name JASH SINGH <br /> Owner DBA <br /> Owner Address PO BOX 21 <br /> TRACY, CA 95378 <br /> Home Phone 209-855-3700 <br /> Work/Business Phone 209-855-3700 <br /> Mailing Address PO BOX 21 <br /> TRACY, CA 95377 <br /> Care of SINGH, JASHARINDERPAL <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021991 10462897 <br /> Facility Name Destination Anywhere Inc <br /> Location 28818 S CORRAL HOLLOW RD <br /> Tracy, CA 95377 <br /> Phone 209-836-9400 x <br /> Mailing Address Po box 21 <br /> TRACY, CA 95377 <br /> Care of Jasharinderpal SINGH <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SONY MANN AKA JASHARINDERPAL SINGI <br /> Title OWNER <br /> Day Phone 209-836-9400 -� ` z:A q D v C I I tT <br /> Night Phone 209-855-3700 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0040094 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name JASH SINGH (Circle One) <br /> Account Balance as of 2/14/2017: $615.00 <br /> (Cirri¢One) <br /> Tran <br /> Program/Element and Description Record ID Employee ID and Name Status New <br /> Transfer <br /> sferto Alive Delete e <br /> eta <br /> 1921 -HMBP-Regular-Primary Location PR0538071 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0538072 EE0000016-BETTY HO Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO540311 EE0009000-HARPRIT MATTU Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSEHD hourly charges associated with his facility or, <br /> be billed to he party identified as he OWNER on this forth I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ander Federal Laws. <br /> APPLICANTS SIGNATURE: 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 Received by <br /> EHD Staff: Date / / Account out: 2K—L-- Date <br /> COMMENTS: <br /> Invoice# <br />