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Date run 11/30/2017 9:09:02A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 11/30/2017 <br /> Record Selection Criteria: Facility ID FA0014439 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) 1 x,30 20/7 <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner I OW0011481 New Owner ID <br /> Owner Name DOLE PACKAGED FOODS LLC-STKN <br /> Owner DBA <br /> Owner Address 7916 W BELLEVUE RD <br /> ATWATER, CA 95301 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-337-0490 <br /> Mailing Address 7916 W BELLEVUE RD <br /> ATWATER, CA 95301 <br /> Care of SCHLEFSTEIN, MICHELLE <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0014439 10184671 <br /> Facility Name DOLE PACKAGED FOOD LLC-STKN <br /> Location 1668 EL PINAL DR <br /> STOCKTON, CA 95205 <br /> Phone 209-337-0490 x <br /> Mailing Address 7916 BELLEVUE RD <br /> ATWATER, CA 95301-2655 <br /> Care of O'Loughlin, Brian <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002-MILLER, KATHERINE Fax <br /> APN 11736042 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 AR0024519 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name DOLE PACKAGED FOOD LLC-STKN (Circle One) <br /> Account Balance as of 11/30/2017: $925.00 <br /> (Circle One) <br /> Transfer to Activennactve <br /> PrograarElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0619297 EE0009817-ROBERT LOPEZ Active Y N A (D D <br /> 2220-SM HW GEN<5 TONS/YR PR0535436 EE9999996-THREE VACANT3 Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0536502 EE0009000-HARPRIT MATTU Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0533138 InactivE Y N A 1 0 <br /> BILLING and COMPLLANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and'or project speck,PHS'EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this farm. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State anNor <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 1. <br /> Payment Type Check Number Received b <br /> EHD Staff: L{ Date / 30 / 2�l Account out: Date <br /> COMMENTS: <br /> e� V� D��a / /� ,�✓1�a�..�f Invoice#: <br /> A,qu-n <br />