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Date run 1123!2014 9:56:36AN SAN JOIN COUNTY ENVIRONMENTAL HEA10 DEPARTMENT Reporf#5021 <br /> Run by Pagel <br /> Facility Information as of 1/23/2014 <br /> Record Selection Criteria: Facility ID FA0020350 <br /> Make changesicorrections in RED ink. A <br /> INFORMATION CHANGE(date) G <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN 1 Fed Tax ID <br /> Owner ID OW0016708 New Owner ID <br /> Owner Name KEEP ON TRUCKING <br /> Owner DBA KEEP ON TRUCKING <br /> Owner Address 608 SNEDEKER AVE <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/Business Phone -90-998-7393 <br /> Mailing Address PO BOX 3209 <br /> RANCHO CUCAMONGA, CA 917293209 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility 1D 1 CERS ID FA0020350 10187583 <br /> Facility Name KEEP ON TRUCKING <br /> Location 608 SNEDEKER AVE <br /> STOCKTON, CA 95203 <br /> Phone 209-938-0750 x0 <br /> Mailing Address 705 CAVANAUGH AVE <br /> STOCKTON, CA 95203 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 003- BESTOLARIDES Fax <br /> APN 16203007 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> New Account ID: <br /> Account ID AR0036337 <br /> Mail Invoices to Owner Mail invoices to: Owner ! Facility 1 Account <br /> (Circle One) <br /> AecountName KEEP ON TRUCKING <br /> Account Balance as of 1/23/2014'. $0.00 (Circle one) <br /> Transfer to Activellnactve <br /> ProgramlElemenf and Description <br /> Record ID Employee ID and Name Status New owner? Delete <br /> 1920-HMBP-Common Materials. PRO535235 EE0009817-ROBERT LOPEZ Active Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0535271 <br /> Inactive Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT1,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this facility <br /> or acuity will be billed to the party identified as the OWNER on this form- 1 also certify that all operations will be performed in accordance with all applicable Ordinance Codes andlor Standards and State andlor <br /> Federal Laws. <br /> 1 1 <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date ! ! <br /> Water System to be TRANSFERED: <br /> Amount Paid Date f 1 <br /> Payment TT Check Number Recei a Date ! ! <br /> REHS: _ ✓ �� Date ^/ Z 1 Account out: <br /> COMMENTS: ( II iti 0 /1 a <br />