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Date run 5/5/2017 4:41:29PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 5/5/2017 <br />Record Selection Criteria: Facility ID FA0019719 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0016176 <br />Owner Name <br />LIAM HARRIS <br />Owner DBA <br />KUEHNE + NAGEL INC <br />Owner Address <br />22 SPENCER ST <br />Phone <br />NAUGUTUCK, CT 06770 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-229-4591 <br />Mailing Address <br />2795 S Paradise Ave <br />Location Code <br />Tracy, CA 95304 <br />Care of <br />005 - ELLIOTT, BOB <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0019719 10483351 <br />Facility Name <br />KUEHNE + NAGEL <br />Location <br />2795 S Paradise Ave <br />Tracy, CA 95304 <br />Phone <br />209-229-4591 x <br />Mailing Address <br />2795 PARADISE ROAD <br />TRACY, CA 95304 <br />Care of <br />LIAM HARRIS <br />Location Code <br />03 -TRACY <br />BOS District <br />005 - ELLIOTT, BOB <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0035081 <br />Mail Invoices to Owner <br />Account Name LIAM HARRIS <br />Account Balance as of 5/5/2017: $3$8:9� <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 />Alt Phone <br />Fax <br />EMail: <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />Zig 1 / (Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PR0529882 EE0000009 - NICHOLAS LOEHRER Active Y N A( I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0531595 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 and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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 b <br />EHD Staff: Date/�/�� Account out: Date /��/ �7 <br />COMMENTS: <br />(� Invoice #: <br />F -A D02zz<7-, <br />