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Date run 12/24/2019 11:30:17/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/24/2019 <br /> Record Selection Criteria: Facility ID FA0022826 <br /> Make changestcorrections 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 OW0020736 New Owner ID <br /> Owner Name R & B LOUISE LLC ETAL <br /> Owner DBA <br /> OwnerAddress 1200 CONCORD AVE 200 <br /> CONCORD, CA 94520 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 925-674-8400 <br /> Mailing Address 1200 CONCORD AVE STE 200 <br /> CONCORD, CA 94520 <br /> Care of REYNOLDS & BROWN <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0022826 <br /> Facility Name NORTH CROSS ROADS BUSINESS PARK <br /> Location 500 E LOUISE AVE <br /> LATHROP, CA 95330 <br /> Phone 925-674-8400 <br /> Mailing Address 1200 CONCORD AVE STE 200 <br /> CONCORD, CA 94520 <br /> Care of DANA PARRY <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0041863 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name R & B LOUISE LLC (Circle One) <br /> Account Balance as of 12/24/2019: $0.00 <br /> (Circle One) <br /> Transferto Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSIYR PR0539909 EE0009818-LYDIA BAKER Inactive Y N A�� D <br /> 2960-RWQCB LEAD AGENCY CLEAN UP SITE PRO540458 EE0001453-NUEL HENDERSON Active Y N A Ft <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 t sfa:tD <br /> iy <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 //Z // � <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 b <br /> EHD Staff: 1Date / / Account out: J Date <br /> COMMENTS: <br /> / Invoice#: <br />