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California Environmental Reporting System (CERS) Business Owner Operator <br /> a01. i .,:,11 i!''. W., NM1_ i rvu:,... a�auu'w.a,--`_ - .,,-.....», e .,,,.� .[,.L..muw,.,6 u+:i,:.,.,Ug, . <br /> MID STATE SURGE CERS 10 <br /> 10182473 <br /> 1436 MAIN ST <br /> ESCALON,CA 95320 <br /> ubmittalStatus <br /> ubmitted on 3/11/2014 by Yvonno Fay of MID STATE SURGE(ESCALON,CA) <br /> ubmittal was Accepted;Processed on 5/29/2014 by Willy Ng for San Joaquin County Environmental Health <br /> Norma Ray Beginning Date Ending Date <br /> perawr Phone Business Phone Business Fax <br /> 209)838-3581 (2098)383-5810 (209)838-8716 Dun&Bradstreet SIC Code Primary NAICS <br /> 068850965 3556 <br /> Facility/Site Mailing Address . rimarY Emergency Contact <br /> 1436 MAIN ST Norma Ray <br /> ESCALON,CA 95320 ritle <br /> FO <br /> usiness Phone 24Hour Phone Pager Number <br /> 209)838-3581 (209)216-7042 <br /> ..._..... ........ ............. <br /> wner ieconclary Emergency Contact <br /> AN VUET,JANET tan Van Vliet <br /> 209)847-5511 itle <br /> 436 MAIN ST P <br /> ESCALON,CA 95320 Iusmess Phone 24Hour Phone Pager Number <br /> 209)838-3581 (209)495-9524 <br /> filling Contact nvironmental Contact _ <br /> MID STATE SURGE vonna Ray <br /> 209)838-3581 yvonnaray@sbcglobal.net 209)838-3581 yvonnaray@sbcglobal.net <br /> 436 MAIN ST L436 MAIN ST <br /> SCALON,CA 95320 SCALON,CA 95320 <br /> Name of Signer Signer Title Document Preparer <br /> vonna Ray CFO Yvonna Ray <br /> Additional Information <br /> 'Locally-collected Fields NE '4 , <br /> ome or all of the following fields may be required by your local regulator(s). <br /> ropertyOwner Assessor Parcel Number(APN) <br /> 22706202 <br /> anet Van Vliet <br /> Number of Employees <br /> hone 22 <br /> 209)847-5511 <br /> Facility ID <br /> ailing Address <br /> 667 Rodden Rd <br /> akdale,CA 95361 <br /> Printed on 7/30/2014 4:06 PM <br />