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Date run 40/9/2018 11:46:52AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by DONNA Pagel <br /> 4 Facility Information as of 10/9/2018 <br /> Record Selection Criteria: Facility ID FA0012470 <br /> Make changesicorrections 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 OW0009672 New Owner ID <br /> Owner Name JOBIN, LOUIS <br /> Owner DBA MANTECA TRUCK ACCESSORIES INC <br /> OwnerAddress 740 N MAIN <br /> MANTECA, CA 95336 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-825-0966 <br /> Mailing Address 740 N MAIN ST <br /> MANTECA, CA 95336 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0012470 10184283 <br /> Facility Name MANTECA TRUCK ACCESSORIES INC <br /> Location 740 N MAIN ST <br /> MANTECA, CA 95336 <br /> Phone 209-825-0966 x0 <br /> Mailing Address 740 N MAIN ST <br /> MANTECA, CA 95336 <br /> Care of JOBIN, LOUIS <br /> Location Code 04-MANTECA Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 22302027 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOBIN, LOUIS <br /> Title <br /> Day Phone 209-823-9892 x0 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020330 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name MANTECA TRUCK ACCESSORIES INC (Circle One) <br /> Account Balance as of 10/9/2 .00 <br /> (Circle One) <br /> Transterlo Active/Inal <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO620882 EE0000009-NICHOLAS LOEHRER Active Y N A © D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO516123 EEO000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO516124 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0534494 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander projectepecgic,PHS/EHD hourly charges associated with this reality <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andfor Standards and State an6'or <br /> Federal Lewis <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 RecelyAd b r <br /> EHD Staff: L..O� Date / / Account out: Date <br /> COMMENTS: 111,e A,S� „�>< -var,G t�Lty gces%✓rftn Elam { HIUBP 07�oi ' n/�Invoice#: <br /> is irwC�tye �r HMe� 0.nd rc4tsn 'Io 0.ecAIlA1}tncj 4-0 rcmbvej�Ges . <br />