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Date run 7!2812017 2:11:23PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7128/2017 <br /> Record Selection Cntena: Facility ID FA0009362 <br /> Make changes/corrections in RED 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 OW0007362 Case Number: H03329 New Owner ID <br /> Owner Name JFD RETYRE INC <br /> Owner DBA JFD RETYRE INC <br /> Owner Address 240 N HUNTER ST <br /> STOCKTON, CA 95202 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-466-4393 <br /> Mailing Address PO BOX 778 <br /> STOCKTON, CA 95201 <br /> Care of DONALDSON, JIM <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0009362 10182627 <br /> Facility Name JFD RETYRE INC <br /> Location 2407 N HUNTER ST <br /> STOCKTON, CA 95202 <br /> Phone 209-466-4393 x <br /> Mailing Address PO BOX 778 <br /> STOCKTON, CA 95201 <br /> Care of JIM DONALDSON <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 13913002 EMail, <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION f <br /> Account ID AR0016362 ls� ✓ New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility ! Account <br /> Account Name JFD RETYRE INC (Circle One) <br /> Account Balance as of 7128/2017: $1,263.40 <br /> (Circle One) <br /> Transfer to Activellnacive <br /> ProgramlElerrient and Description Record ID Employee ID and Name Status Nnw nwna(J Delete <br /> 1920-HMBP-Common Materials PR0519579 EE0009817-ROBERT LOPEZ Active Y N AD <br /> 2220-SM HW GEN<5 TONSIYR PR0513788 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511650 EE0000000-HAZ MAT SJC OES Inactive Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509362 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0522405 EE0004486-ANGELICA SANDOVAL MARIt Active Y N A 'I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE PRO531409 Inactive Y N A �f/ D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersgned owner,operator or agent of same,acknowledge that all site,andfor project specific.PH51EHO hourly charges associated with this <br /> facility or activity will be billed to the party identdied as the OWNER on[his form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andlor Standards <br /> and State and'or Federal Laws_ <br /> APPLICANT'S SIGNATURE: Date 1 / <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date I I <br /> Water System to be TRANSFERED: Amount Paid Date ! I <br /> Payment Type C eck Number Received y <br /> EHD Staff: ,' z" — Date 1 1 17 Account out: Date I I <br /> coM T„ <br /> V4d <br /> Invoice#: <br />