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Date run 4/26/2016 8:51:52AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 412612016 <br /> Record Selection Criteria, Facility ID FA0019302 <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 1 Fed Tax ID <br /> Owner ID OW0015844 New Owner ID <br /> Owner Name PAUL PFLUG <br /> Owner DBA PFLUG PACKAGING & FULLFILLMENT <br /> OwnerAddress 17500 SHIDELER PARKWAY <br /> LATHROP, CA 95330 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-206-0951 <br /> Mailing Address 17500 SHIDELER PARKWAY <br /> LATHROP, CA 95330 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CELS ID FA0019302 10187187 <br /> Facility Name PFLUG PACKAGING & FULLFILLMENT <br /> Location 17500 SHIDELER PKWY <br /> LATHROP, CA 95330 <br /> Phone 209-858-9170 x0 <br /> Mailing Address 17500 SHIDELER PARKWAY <br /> LATHROP, CA 95330 <br /> Care of PAUL PFLUG <br /> Location Code Q7- LATHROP Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 19823018 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 AR0034316 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner ! Facility 1 Account <br /> Account Name PAUL PFLUG (Circle One) <br /> Account Balance as of 4126/2016: $0.00 <br /> (Circle Ones <br /> Transferto Activellnactve <br /> Program/Element and Description Record to Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0528739 EE0000010-PETER LOMBARDI Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO540125 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO533244 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific.PHSIEHD 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 andlor Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> EHD Staff: Date f 1 Account out: Date 1 1 <br /> COMMENTS: Invoice : <br />