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Date run 9/29/2015 9:25:02AR SAN J(WIN COUNTY ENVIRONMENTAL HEA*DEPARTMENTReport/5021 <br /> Run by Pagel <br /> Facility Information as of 9/29/2015 <br /> Record Selection Criteria: Facility ID FA0021991 <br /> Make changestcorrections 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 OW0018105 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 lD/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 p0 box 21 <br /> TRACY, CA 95377 <br /> Care of Jasharinderpal SINGH <br /> Location Code Alt Phone <br /> BOIS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SONY MANN AKA JASHARINDERPAL SINGE <br /> Title OWNER <br /> Day Phone 209-836-9400 <br /> Night Phone 209-855-3700 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0040094 NewAccount ID: <br /> Maillnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name Destination Anywhere Inc (Circle One) <br /> Account Balance as of 9/29/2015: $0.00 <br /> (Circle One) <br /> Program/Element and DescriptionRecord ID Employee ID and Name Status Transfer to Activellnectve <br /> New Owner1 Delete <br /> 1920-HMBP-Common Materials PRO538071 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN c5 TONS/YR PR0538072 EE0002646-THUY TRAN 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: I,the undersigned!owner,operator or agent of same,acknowledge that all site,andor project specific,PHSrEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on Nis 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: 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: Date_/_/ <br /> COMMENTS: <br /> Invoice 1{: <br />