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Data ran 4/28/2017 2:58:05PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/28/2017 <br /> Raced Selection Cntena: Facility ID FA0009619 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number f pities for this owner: 2 SSKI Fed Tax ID <br /> Owner ID OW00 393 Case Number: H03711 New Owner ID J <br /> Owner Name 4 91d CGE^ �' �!n t44e- <br /> Owner DBA v.._ <br /> Owner Address 7L+o/ !r: i +ti <br /> � z '7-zs <br /> Home Phone Not Specified <br /> Work/Business Phone 2eg=6gg-o83g, SS'-Y -' 3 L-0 <br /> Mailing Address— c 11i442---7 <br /> GA ^257'1'7 <br /> Care of ^mss—T <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009619 10182801 <br /> Facility Name lam.__-flaw( M r vac Er K!r <br /> Location 825 NAVY DR <br /> STOCKTON, CA 95206 <br /> Phone -209.944.5821—X <br /> Mailing Address Pg� �a X- 12-14-2--7 <br /> S c-A —75722-7 <br /> Care of 1 -REEK <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 16326035 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 AR0016619 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner cgilityj/ Account <br /> 10 Account Name INTERSTATE TRUCK CNTR (Circle One) <br /> A�gc�lnt Balance as of 4/28/2017: $0.00 <br /> VV (Cirde One) <br /> Transfer to Adive/Ina rie <br /> ProgramlElement and Deacnption RecordID Employee ID and Name Status New OwneR Delete <br /> 1 -HMBP-Regular-Primary Location PRO519777 EE0009817-ROBERT LOPEZ Inactive Y N A I D <br /> 222 HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511907 EE0000000-HAZ MAT SJC OES Inactive Y N I D <br /> 2227 GEN 5<25 TONS PERMIT PRO513932 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> UST FACILITY(BEFORE 1/a4)-obsolete PRO502102 EE0000418-MICHAEL KITH Inactive Y N I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509619 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0528424 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO527911 EE0009000-HARPRIT MATTU Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531678 Inactive Y N A I D <br /> /--W -"7 <br /> �C'� lrG>r�i+s he L✓ C � t/0* <br /> B, y/Z� /1-7I <br />