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Date run 12/30/2016 3:34:58P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 45021 <br /> Run by <br /> Facility Information as of 12/30/2016 Pagel <br /> Record Selection Criteria: Facility ID FA0014410 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) 230 �� <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner 1D OW0011452 New Owner ID <br /> Owner Name .EiA&rr'fIAiC�lnnt -• - .. c� r� <br /> t�tvlI� .� �L _! /rail t.- So N✓' r_ o _r�_�c-• l i o !tea GC �itc <br /> Owner DBA -� TEMS <br /> OwnerAddress L <br /> Home Phone Not Specified <br /> Work/Business Phone _ 7 b <br /> Mailing Address <br /> f <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0014410 <br /> Facility Name _ING SYSTEMS_ <br /> Location 1928 BOEING WAY STE <br /> STOCKTON, CA 95206 (¢j <br /> Phone,299 <br /> Mailing Address 1 PR/N, SOUI� �Care ofLocation Code BUILDING PRODUCTS, INC. <br /> BOS District <br /> APN CHRIS MARSHALL <br /> OPERATIONS MANAGER <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION TELEPHONE 209/297-0003 STOCKTONDC44 <br /> Contact Name TOLL-FREE 800/966-6158 1928 BOEING WAY <br /> Title FACSIMILE 209/251.0244 STOCKTON,CA 95206 <br /> Day Phone MOBILE 209/629-1079 WEBSITE www.primesourcebp.com <br /> Night Phone <br /> EMAIL marshallc@primesourcebp.com www.grip-rite.com <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR002 490 NewAccount ID; <br /> Mail Invoices to OW Mai!Invoices to: Owner / Facility 1 Account <br /> Account Name Circle One) <br /> �,�,.� <br /> Account Balance as of 12/30/2016: $0.00 Glrils <br /> 66 (Circle One) <br /> Transfer to Activellractve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0519268 EE0009817-ROBERT LOPEZ InactivF Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1 the undersigned owner,operator or agent of same,acknowledge that all site,and1cr project specific,PH&EHD hourly charges associate wi s facility <br /> or activity will be billed to the party identified as the OWNER on this farm. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards tate andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date ! 1 <br /> Water System to be TRAN FERED: Amount Paid Date / <br /> Payment Type Check Nu ber Received b <br /> EHD Staff: Date / / Account out: Date l _l� <br /> COMMENTS: <br /> Invoice#: <br />