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Date run 2/15/2017 2:03:32PK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by DONNP. Paget <br />Facility Information as of 2/15/2017 <br />Re Id Selecti; Criteria: Facility ID FA0018753 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0015420 <br />Owner Name <br />Greg Anderson CFO <br />Owner DBA <br />X,"���trt a;lhe— <br />Owner Address <br />1616 BOEING WAY <br />Phone <br />STOCKTON, CA 95206 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />321-281-9245 <br />Mailing Address <br />225 E Robinson St <br />Location Code <br />Orlando, FL 32801 <br />Care of <br />001 - VILLAPUDUA, CARLOS <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0018753 10669621 <br />Facility Name <br />IGPS Logistics LLC <br />Location <br />1616 Boeing Way <br />Stockton, CA 95206 <br />Phone <br />209-390-0063 x4 <br />Mailing Address <br />1616 Boeing Way <br />Stockton, CA 95206 <br />Care of <br />Thomas Ghilardi <br />Location Code <br />01 - STOCKTON <br />Bos District <br />001 - VILLAPUDUA, CARLOS <br />APN <br />17713035 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name / <br />Title / <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0033298 <br />Mail Invoices to Account <br />Account Name C <br />Account Balance as of 2/15/2017: $194.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />New Account ID: <br />Mail Invoices to: Owner / Facility / count <br />(Circle One) <br />Transfer to Active/lnactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1920 - HMBP-Common Materials PR0527669 EE0009817 - ROBERT LOPEZ Active Y N A I D <br />2227 - GEN 5<25 TONS PERMIT PRO529791 EE0001421 - STACY RIVERA Inactive Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0534526 Inactive Y N A I D <br />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 <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 andtor Standards and State and(or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: <br />COyM�MMENTS. <br />' $25.00 = <br />Date L/ / <br />Date <br />Amount Paid Date _/_/ <br />_ Amount Paid Date <br />Received by <br />Account out: (.A-5 Date / -2� 0 <br />Invoice #: <br />