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Date tan 12/4/2017 2:15:25PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/4/2017 <br /> Record Selection Criteria: Facility ID FA0009193 <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: 1 SSN/Fed Tax 10 <br /> Owner ID OW0007193 Case Number: H01882 New Owner ID <br /> Owner Name P&L CONCRETE PROD INC <br /> Owner DBA P&L CONCRETE PRODUCTS INC <br /> OwnerAddress 1900 ROOSEVELT AVE <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-838-1448 <br /> Mailing Address 1900 ROOSEVELTAVE <br /> ESCALON, CA 95320 <br /> Care of FRANCIS, JEFFREY R <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009193 10182499 <br /> Facility Name P&L CONCRETE PRODUCTS INC <br /> Location 1900 ROOSEVELT AVE <br /> ESCALON, CA 95320 <br /> Phone 209-838-1448 x <br /> Mailing Address 1900 ROOSEVELTAVE <br /> ESCALON, CA 95320 <br /> care of Arlene Francis <br /> Location Code 06- ESCALON Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 22710007 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 AR0016193 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Arlene Francis (Circle One) <br /> Account Balance as of 12/4/2017: $0.00 <br /> (Circe One) <br /> Transfer to ActiveAnectve <br /> PrograrNElement and Desclptlan Record ID Employee ID and Name Status New Owner! Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519450 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0513695 EE0000032-JOHN ALANIZ Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO611481 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE Fl PR0509193 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0535394 EE0009000-HARPRIT MATTU Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532954 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent at same,acknowledge that all site,ancor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also cengy that all operalicne will be performed in accordance with all applicable Ordinance Codes ander Stenderds and State and'or <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: Invoice#: <br />