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Date run 6/29/2015 3:45:15Pry SA*AQUIN COUNTY ENVIRONMENTAL <br /> Run by Report DEPARTMENT Report#5021 <br /> Facility Information as of 6/29/2015 Pagel <br /> Record Selection Criteria: Facility ID FA0022974 <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: 3 SSN/Fed Tax ID : <br /> Owner ID OW0014770 New Owner ID <br /> Owner Name SINGH, GURPARTAP <br /> Owner DBA SUBWAY <br /> OwnerAddress 1135 PALOMAR CT <br /> TRACY, CA 95377 <br /> Home Phone 209-390-4050 <br /> Work/Business Phone 209-321-5656 <br /> Mailing Address 1135 PALOMAR CT <br /> TRACY, CA 95377 <br /> Care of SINGH, GURPARTAP <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0022974 <br /> Facility Name SUBWAY G2325 INC <br /> Location 7503 W ELEVENTH ST <br /> TRACY, CA 95304 <br /> Phone 209-321-5656 <br /> Mailing Address 1135 PALOMAR CT <br /> TRACY, CA 95377 <br /> Care of SINGH, GURPARTAP <br /> Location Code 03-TRACY Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SINGH, GURPARTAP <br /> Title <br /> Day Phone 209-321-5656 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0042138 NeW ACCOunt ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SUBWAY G2325 INC (Circle One) <br /> Account Balance as of 6/29/2015: $290.00 <br /> (Circle One) <br /> Transferto ActiveAnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 1623-RESTAURANT/BAR 1-20 SEATS PRO540186 EE0001 420-MELISSA NISSIM Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO540223 EE0002474-MICHAEL PARISSI 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 speck,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party identfled as the OWNER on this form, t also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <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#: <br />