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Date run 8/18/2017 9:48:25AR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 8/18/2017 Pagel <br /> Record selection Criteria: Facility ID FA0016552 <br /> Make changes/corrections ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0013407 New Owner ID <br /> Owner Name BARAJAS, GRISELDA <br /> Owner DBA CORONA PM ROAD SERVICE <br /> OwnerAddress 1887 E 11TH ST <br /> STOCKTON, CA 95206 <br /> Home Phone 209-495-0768 <br /> Work/Business Phone 209-932-0598 <br /> Mailing Address 2327 MARIPOSA RD <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016552 10185189 <br /> Facility Name CORONA PM ROAD SERVICE <br /> Location 2327 MARIPOSA RD <br /> STOCKTON, CA 95205 <br /> Phone 209-932-0598 x <br /> Mailing Address 2327 MARIPOSA RD <br /> STOCKTON, CA 95205 <br /> Care of Griselda Barajas <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 17129016 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Griselda Barajas <br /> Title Owner <br /> Day Phone 209-932-0598 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029189 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CORONA PM ROAD SERVICE (Circle One) <br /> Account Balance as of 8/18/2017: $0.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> Program/Element and Desu ption Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO524649 EE0009817-ROBERT LOPEZ Active Y N AS D <br /> 2228-GEN 25<50 TONS PERMIT PR0538510 EE9999996-THREE VACANT3 Active Y N AD <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO541109 EE9999996-THREE VACANT3 Active Y N A m D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO524826 EE0000060-JENNIFER FRASE Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0531397 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operstor or agent or same,so nowledge that all site,andor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party Identi ied as the ONMER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Lewis. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to TRANSFERED: Amount Paid Date I / <br /> Payment Typer Check Number Received b �7 <br /> EHD Staff: usalk Date �Z /I£[,/_177 Account out: Date / 2__1 / <br /> COMMEN S: <br /> Invoice#: <br />