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Date run 5120/2014 s:09:18AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT itsiz <br />Papal <br />Run by Facility information as of 5/20/2014 <br />Re ,d Selecdon Gdteda: Faaity In FA0003541 <br />Make changes/cOrractlOns in RED InK. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) June 1, 2014_ <br />OWNER FILE INFORMATION Number of facilities for this owner 1 SSN / Fed Tax ID :39-1412212 <br />owner ID OW0002647 <br />New Owner ID : <br />owner Name BLINCOE, JANET <br />Foodliner, Inc. <br />Owner DBA BJJ COMPANY LLC <br />Elf ..- <br />OwnerAddress 2431 E MARIPOSA RD <br />2099 Southpark Ct., Suite 1 <br />STOCKTON, CA 95205 <br />Dubuque, IA 52003 <br />Home Phone Not Specified <br />Not Specified <br />Work/Business Phone 209-941-8361 <br />563-584-2672 <br />Mailing Address PO BOX 30010 <br />2099 Southpark Ct., Suite 1 <br />STOCKTON, CA 95213 <br />Dubuque, IA 52003 <br />Care of <br />FACILITY FILE INFORMATION <br />Site Mitigation Facility <br />Facility ID / CERS ID FA0003541 10181211 <br />Facility Name BJJ COMPANY LLC <br />Foodliner, Inc. <br />Location 2431 E MARIPOSA RD <br />STOCKTON, CA 95205 <br />Phone 209-941-8361 x <br />Mailing Address PO BOX 30010 <br />2099 Southpark Ct., Suite 1 <br />STOCKTON, CA 95213 <br />Dubuque, IA 52003 <br />Care of Bill McCarty <br />Location Code 01-STOCKTON <br />Alt Phone <br />SOS District 001 - VILLAPUDUA <br />Fax Not Specified <br />APN 17130003 <br />EMail: steveh@foodliner.com <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Steve Hronek <br />Tale <br />Site Manager <br />Day Phone <br />209-941-8361 <br />Night Phone <br />None Specified <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0003120 <br />New Account ID: <br />Mail Invoices to 2099 Southpark Ct, Dubuque, IA 52003 Mail Invoices to: owner / Facility I <br />Account <br />Account Name Foodliner, Inc. <br />(Gide one) <br />Account Balance as of 5/20/2014: $0.00 <br />(Clyde One) <br />Translerto <br />Actiennadea <br />Progranry cement and Descnix m Ramrd ID <br />Employee ID and Name statns New Owner? <br />Delete <br />1921 - HMSP-Regular-Primary Location PRO519468 <br />EE0009817 - ROBERT LOPEZ Active Y N <br />A 1 D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511503 <br />EE0000000- HAZ MAT SJC DES Inactive Y N <br />A I D <br />2227 - GEN 5<25 TONS PERMIT PRO513705 <br />EE0001421 - STACY RIVERA Active Y N <br />A IZZ D <br />2361 - UST FACILITY PR0231818 <br />EE0001421 - STACY RIVERA Active Y N <br />A \��\ D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PR0507346 <br />EE0000008 - LETITIA, BRIGGS Inactive Y N <br />A D <br />2831 -AST FAC >/= 1,320 - -10 K GAL CUMULATIVE PR0528562 <br />EE0001 421 -STACY RIVERA Active,l Y N <br />A 1 0 <br />4740 - WASTE TIRE SITE - EXEMPT PRO523530 <br />EE0009000 - HARPRIT MATTU Active Y N <br />A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0532596 <br />Inactive Y N <br />A I D <br />4630- NTNC WATER SYSTEM WA0461334 <br />EE0005838 -ADRIENNE ELLSAESSER Active Y N <br />A I D <br />BILLING ar COMPLIANCE ACKNOWLEDGEMENT, 1, tlw undangned owner, eparetor or egaMo.a.adawwbdW Mat ell site, endorproject""I PHSTHD hou0ytl+m9eaaseodated with Mk re ktyor. <br />be billed to are party iderrtRretl as Iha OWNER on this form. I also neday Mel all oparatiaw will Da perrormad'n acwNanca wiM ell epplirabk OMinanw Cedes ardor S(arMartls and State ands Fetlerel Laws. <br />APPLICANT'S SIGNATURE: t� U Y 1 <br />VAP A S�l d M Data 5 / 23 , J 4 <br />r <br />Program Records to be TRANSFERED: ' $25.00 = <br />Amount Pak) Date <br />Water System to be TRANSFERED: <br />Amount Paitl Date //_ <br />Payment Type Check Number �f-,' Re y <br />RENS: Date /,kyr Aomunt out: Date <br />COM1atENTS: <br />