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Date ren 3/7/2017 4:33:22PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repo"#5021 <br /> Run by Pagel <br /> Facility Information as of 3/7/2017 <br /> Record Selection Criteria: Facility 10 FA0014439 <br /> Make changes/corrections 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 10 : <br /> Owner ID 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 4668 El� Fatill'tI_1; �, <br /> see } ,Af a+e_ I— t C, 5'301 —.1655 <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 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility I Account <br /> Account Name DOLE PACKAGED FOOD LLC-STKN cipple One) <br /> Account Balance as of 3/7/2017: $825.00 <br /> (Circle One) <br /> Trenseir to Active/leacive <br /> Program/Element and Description Record ID Employee ID and Name status New Owner/ Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519297 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO535436 EE0000023-PAULINE MANGRAI Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0536502 EE0009000-HARPRIT MATTU Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533138 Inactive Y N A 1 D <br /> 6ILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andar project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as Ne OWNER on this term. I also candy that all operations will be performed in accordance with ell applicable Ordinance Codes ondor Standards and State ander <br /> 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 I / Account out: Date�/�/LZ <br /> COMMENTS: <br /> Invoice#: <br /> M«, 1xa , ctJ&lrebs G kc rj5e- cti % Felf i e %)r,\ MC41% \ <br />