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Date run 8/3/2015 4:12:25PM SAN JUIN COUNTY ENVIRONMENTAL HEAJAH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/3/219 <br /> Record Selection Criteria: Facility ID FA0015051 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> - <br /> OWNERFILEINFORMATION Number of facilities for this owner: 4 SSN/Fed Tax ID : <br /> Owner ID OW0002224 New Owner ID <br /> Owner Name HARDEEP AND SONS INC <br /> Owner DBA SUBWAY <br /> Owner Address 1184 PYRENEES CT <br /> TRACY, CA 95304 <br /> Home Phone 209-640-1000 <br /> Work/Business Phone Not Specified <br /> Mailing Address 25440 S SCHULTE RD <br /> TRACY, CA 95377 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0015051 <br /> Facility Name SUBWAY <br /> Location 959 S TRACY BLVD <br /> TRACY, CA 95376 <br /> Phone 209-832-8151 <br /> Mailing Address 25440 S SCHULTE RD <br /> TRACY, CA 95377 <br /> care of SINGH, HARDEEP <br /> Location Code 03 -TRACY Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 24202022 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SINGH, HARDEEP <br /> Title <br /> Day Phone 209-832-8151 <br /> Night Phone 209-640-1000 Cell <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025747 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name SUBWAY (Circle One) <br /> Account Balance as of 8/3/2015: $0.00 <br /> (Circle One) <br /> Transferto ActiveMactse <br /> Progranâś“Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1624-RESTAURANT/BAR21-50 SEATS PR0522090 EE0001420-MELISSA NISSIM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHO 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 ander Standards and State ander <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 />