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Date run 9/12/2018 4:04:36PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 Run by Pagel Facility Information as of 9/12/2018 Record Selection Criteria: Facility ID FA0020551 OWNER FILE INFORMATION Number of facilities for this owner Owner ID OW0002224 owner Name HARDEEP AND SONS INC Owner DBA SUBWAY OwnerAddress 1184 PYRENEES CT Phone TRACY, CA 95304 Home Phone -2$9-83�- 7 Work/Business Phone TRACY, CA 95377 Mailing Address 25440 S SCHULTE RD Location Code TRACY, CA 95377 Care of HARDEEP AND SONS INC FACILITY FILE INFORMATION Facility ID / CERS ID FA0020551 10187647 Facility Name SUBWAY Location 25440 S SCHULTE RD TRACY, CA 95377 Phone 1209-bJb-242 7— Mailing Address 25440 S SCHULTE RD TRACY, CA 95377 Care of HARDEEP SINGH Location Code 99 - UNINCORPORATED A Bos District 005 - ELLIOTT, BOB APN 20944034 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name HARDEEP SINGH Title Day Phone &35--22tt7 Night Phone 209-640-1000 Cell ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0036755 Mail Invoices to Facility Account Name SUBWAY Account Balance as of 9/12/2018: $350.00 Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) 4 SSN / Fed Tax ID New Owner ID : 1� - 12-c `a Alt Phone Fax EMail : Mail Invoices to New Account ID: : Owner / Facility / Account (Circle One) (Circle One) Transfer to Active/Inactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1623 - RESTAURANT/BAR 1-20 SEATS PR0535634 EE0004589 - KADEANNE LINHARES Active Y N A I D 1919 - HMBP-0O2 Only Food Facility PR0535955 EE0004589 - KADEANNE LINHARES Active Y N A I D ERSC - ELECTRONIC REPORTING STATE SURCHARGI PR0535963 Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly charges associated with this facility 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 anclor Standards and State andlor Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Recei ed by. EHD Sta .�,. Date / 12 / QJ Account out: Date / 12—/ COMMENTS_ Invoice #: