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a 4/8r'204Q- F Information:Business Da-ear/Operator Notification:CS Reg ulator <br /> California Environmental Reporting System:Regulator [Obert Lopez's Account Sign 1 ut Tests Rewr,{,2 FHeID <br /> Submittals Facifitiee: Reguiaiors Compliance Responders Reports <br /> Business Owner/Operator Identification: JACK IN THE BOX #3408 <br /> Hnme » vu bm dtot Search N Subm.tla1:121412014(10180991) it '.. rr ldentificabor, Aceeptedi <br /> Submitted for CERS ID 10180991 on 12/4/2014 3:06PM by Dolores Kaufman of Jack In The Box(Fremont CA) <br /> Submittal was Accepted on 12/10/2014 by EHINTERN for San Joaoum County Environmental Health <br /> i <br /> am <br /> Rcum:,StEmtcal I <br /> JACK IN THE BOX#3408 <br /> 4989 S H WY 99 <br /> STOCKTON, CA 95215 <br /> entfficatbn <br /> Varris Management Inc Beginning Date F Ending Dale# <br /> Operator Phone Business Phone#Business Fax# 12/4/2014 12/3/2015 <br /> (510)792-3393 (209)943-2157 0- Dun 8 Bradstreet a SIC Code 49 Primary NAICS r0n <br /> acNftyiSite-Meiling--Address-- PNmaty-Emergency—ante <br /> 989 S State Rt 99 E Frontage Rd Teresa Hale <br /> Stockton, CA 95205 Title <br /> District Manager <br /> Business Phone 24-Hour Phone#Pager Number# <br /> Anil Yadav (2 -1298 - <br /> Phone <br /> (510)792-3393 m" <br /> Mailing Address INo Name Provided] <br /> 3550 Mowry Ave#301 Title 0, <br /> Fremont, CA 94538 <br /> Business Phone,#24-Hour Phone 1?Pager Num her a$ <br /> Jack in the Box#3408 <br /> Phone —Environmental-Contact <br /> (510)792-3393 Scott Johnson <br /> - (510)598-7772 <br /> Mailing Address <br /> 3550 Mowry Ave#301 Mailing Address <br /> Fremont, CA 94538 3550 Mowry Ave#301 <br /> --- Fremont, CA 94538 <br /> ® �C ER9 Flelp Settings ®Notificavons_ <br /> Name of Signer# Title' <br /> __ _... _.______._.__ _._ �____ .. -._ Li <br /> Dolores Kaufman District Manager Dolores Kaufman <br /> Additional information <br /> ocatycotiacted F. <br /> Some or all of the following fields maybe required byyour local regulator(s). <br /> I <br /> Property Ow is <br /> Assessor Parcel Number(APM W <br /> Mil Yad av <br /> Number of Fan ployees## <br /> Phone 20 <br /> (510)792-3393 <br /> Facility ID Number(Regulator-provided) <br /> Mailing Address <br /> 3550 Mowry Ate#301 <br /> Fremont, CA 94538 <br /> Created By:Dolores Kaufman on 12/412014 2:12 PM to Stlbniital <br /> last Updatad By:Dolores Kaufman on 1214/2014 2:12 PM <br /> n t:.',R10 I C 11 Ao-'erre it,1 U ,!:meat IV a osli^s 2Conditens or lbeKiva„y rbkre l GQ'ItArtI I let <br /> https://cersreg Ldator2.calepa.ca.goVBLriness/135343tFEicility410180991/Submittal/FI/924768/OmvrOperstor/DetailIM1487 1/2 <br />