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ERecord <br /> 1015/2017 8:45:48AIN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report#502T <br /> Facility Information as of 10/5/2017 Pagel <br /> election Criteria: Facility ID FA0023741 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner ID OW0022077 New Owner ID <br /> Owner Name QAMAR HUSSAIN <br /> Owner DBA US TRUCK TRAILER REPAIR INC <br /> Owner Address 4463 TRINIDAD CT <br /> STOCKTON, CA 95210 <br /> Home Phone 209-518-7839 <br /> Work/Business Phone 209-518-7839 <br /> Mailing Address 4310 S. HWY 99 FRONTAGE RD <br /> STKN, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0023741 10726102 <br /> Facility Name U S TRUCK TRAILER REPAIR INC <br /> Location 4310 S HVVY 99 FRONTAGE RD <br /> STOCKTON, CA 95215 <br /> Phone 209-451-1766 x <br /> Mailing Address 4310 S. HWY 99 FRONTAGE RD <br /> STKN, CA 95215 <br /> Care of QAMAR HUSSAIN <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 179-172-350-00! 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 AR0043927 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name QAMAR HUSSAIN � � (Circle One) <br /> Account Balance as of 10/5/2017: $455.00 <br /> �} (Circle one) <br /> ']jam Transfer to Active/IrlP gr m�a ent and Description Record ID Employee ID and Name Status New Owner? Delete <br /> _1920-HMBP-Common Materials PR0541922 EE0008709-JAMIE LIMA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0541425 EE0000031 -ELIANNA FLORIDO Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned owner,operator or agent of same,acknowledge that all site,andtor project specific,PHS/EHD hourly charges associated with this facility <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 and+or Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: $25 00= Amount Paid Date I <br /> Water System to be TRANSFERED: Amount Paid Date ! ! <br /> Payment Tyje Check Number Received by, <br /> EDate f r l�� Account out: �,LJ Date I I <br /> COMMENTS: <br /> Invoice 11 <br />