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Date run 6/17/2015 8A1:42AA SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> R� ✓j Pagel <br /> Facility Information as of 6/17/2015 <br /> Record Selection Criteria: Facility ID FA0014687 <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 OW0011698 New Owner ID <br /> Owner Name Pozas/ Petersen <br /> Owner DBA POZAS BROS TRUCKING CO , 2 L-tL' _g <br /> Owner Address 8130 ENTERPRISE DR p t r .- <br /> NEWARK, CA 94560 <br /> Home Phone Not Specified <br /> Work/Business Phone 510-742-9939 `7 - S`7'6�- -2 <br /> Mailing Address 8130 Enterprise Drive <br /> Newark, CA 94560 ����,J�fi�._ _ Ci4 19 S <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0014687 10184739 <br /> Facility Name POZAS BROS TRUCKING CO <br /> Location 3018 E LOOMIS RD <br /> STOCKTON, CA 95205 <br /> Phone 510-742-9939 x �`l <br /> Mailing Address 8130 Enterprise Drive5.21 <br /> Newark, CA 94560 <br /> Care of Pozas Bros Trucking Co.,lnc _- <br /> Location Code Alt Phone <br /> BOS District 001 - VILLAPUDUA, CARLOS Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GERALD BRAND ✓��� v +Ir✓` g-1 <br /> Title <br /> Day Phone 510-742-9939 -7 Z-6 <br /> Night Phone 209-339-4738 Z _) - 2 J_,,-2 - <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024994 New Account ID: : <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name Pozas/ Petersen (Circle One) <br /> Account Balance as of 6/17/2015: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owners Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0521613 EE0008709-JAMIE DE LA ROSA InactivE (:�) N 1 D <br /> 2831 -AST FAC >/= 1,320-<10 K GAL CUMULATIVE PR0538267 EE0001421 -STACY RIVERA InactivE Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534342 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 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 by <br /> EHD Staff. Date Account out: Date <br /> COMMENTS. I Invoice#: q12 `��l/��✓ <br /> � �-�,� � , � � � <br /> I yl t0�`�IJ� Tt �7 / '1�l��TCY I 4— <br /> I <br /> Cil <br /> ��� <br />