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Date rein 12/29/2016 12:44:32F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/29/2016 <br /> Record Selection Criteria: Facility ID FA0019675 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) Z-17—9 al <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN I Fed Tax ID <br /> Owner ID OW0016132 New Owner ID <br /> Owner Name C&R INTERNATIONAL SALES INC <br /> Owner DBA C&R INTERNATIONAL SALES INC <br /> OwnerAddress 2403 NAVY DR <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-943-1777 <br /> Mailing Address PO BOX 577228 <br /> MODESTO, CA 95357-7228 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0019675 10187301 <br /> Facility Name C&R INTERNATIONAL SALES INC <br /> Location 2403 NAVY DR <br /> STOCKTON, CA 95206 <br /> Phone 209-943-1777 x0 <br /> Mailing Address PO BOX 577228 <br /> MODESTO, CA 95357-7228 <br /> Care of C&R International Sales <br /> Location Code Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 16332002 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 AR0035037 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility 1 Account <br /> Account Name C&R INTERNATIONAL SALES INC (Circle one) <br /> Account Balance as of 12/29/2016-. $0.00 <br /> (Circle One) <br /> Program/Element and pescriptionTransfer to Record ID Employee ID and Name Status New Owner? Delete <br /> the <br /> 1921 -HMBP-Regular-Primary Location PRO529838 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO535659 EE0009000-HARPRIT MATTU Active Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO531441 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT; I the undersigned owner,operator or agent of some,acknowledge that all site,and+or project specific,PH$IEHO 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 anti Standards and State andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 ! <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date / ! <br /> Payment Type, Check Number Received by <br /> EHD Staff: SL 2 Date !2 1 2-9 l Account out: U— Date f Z 1-3v I L <br /> COMMENTS: <br /> Invoice#: <br />