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Date run 4/23/2014 9:57:41AI1 SAN JO VIN COUNTY ENVIRONMENTAL HEAT I DEPARTMENT <br /> Run by Report 95021 <br /> Facility Information as of 1/23/2t1�4 Pagel <br /> Record Selection Criteria: Facility ID FA0018385 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) 142 Z <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner fD OW0015104 New Owner fD : <br /> Owner Name KEEP ON TRUCKING CO LLC <br /> Owner DBA KEEP ON TRUCKING CO LLC <br /> Owner Address 509 EMBARCADERO ST <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/Business Phone 800-825-1205 <br /> Mailing Address PO BOX 3209 <br /> RANCHO CUCAMONGA, CA 91729 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0018385 10186851 <br /> Facility Name KEEP ON TRUCKING CO LLC <br /> Location 509 EMBARCADERO ST <br /> STOCKTON, CA 95203 <br /> Phone 209-938-0750 x0 <br /> Mailing Address PO BOX 3209 <br /> RANCHO CUCAMONGA, CA 91729 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032432 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility 1 Account <br /> Account Name KEEP ON TRUCKING CO LLC (Circle One) <br /> Account Balance as of 1/23/2014: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO527126 Inactive Y N AD <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO528531 EE0004636-GARRETT BACKUS Active,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531508 Inactive Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT, I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specific,PHSrEHD hourly charges associated with this facility <br /> or activity will be billed 10 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 andfor <br /> Federal Laws <br /> APPLICANT'S SIGNATURE: Date / 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date ! 1 <br /> Water System to be TRANSFERED: Amount Paid Date ! / <br /> Paymentpe Check Number Receiv <br /> REHS: V Date_�/ Z2-/ Account out: Date 1 / <br /> COMMENTS: �w. � r to <br />