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Report#5021 <br /> Date run 9/2812015 11:03:12AI SAN JUIN COUNTY ENVIRONMENTAL HESH DEPARTMENT Pagel <br /> Run by Facility Information as of 9/2812015 <br /> Record Selection Criteria Facility ID FA0015953 <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 OW0012878 New Owner ID <br /> Owner Name TRAVLN TOYS <br /> Owner DBA <br /> Owner Address 21200 PARADISE RD <br /> TRACY, CA 95304 <br /> Home Phone 209-833-9111 <br /> Work/Business Phone 209-833-9111 <br /> Mailing Address 21200 PARADISE RD <br /> TRACY, CA 95304 <br /> Care of TRAVLN TOYS <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0015953 10185059 <br /> Facility Name TRAVLN TOYS <br /> Location 21200 PARADISE RD <br /> TRACY, CA 95304 <br /> Phone 209-833-9111 X <br /> Mailing Address 21200 PARADISE RD <br /> TRACY, CA 95304 <br /> Care of REMITZ, TERRY <br /> Location Code 03-TRACY Alt Phone <br /> Fax <br /> BOS District <br /> APN 21317003 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION New Account ID: <br /> Account ID AR0027823 <br /> Mail Invoices to: Owner 1 Facility 1 Account <br /> Mail Invoices to Facility (Circle One) <br /> Account Name TRAVLN TOYS <br /> Account Balance as of 912812015: $0.00 (Circle One) <br /> Transfer to Actmonactve <br /> Program/Element and Description <br /> Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP Regular Primary Location PR0524138 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> PRO524708 EE0002646-THUY TRAN Active Y N A I D <br /> 2220-SM HW GEN<5 TONSIYR <br /> PR0523635 EE0002622-BENJAMIN ESCOTTO Active Y N A <br /> 4740-WASTE TIRE SITE-EXEMPT <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534757 Inactive Y N A I D <br /> hourly cha� <br /> d with this facility <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or protect I cable Ordin�anco CCodes ndfoestandards eand State andfor <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 app <br /> Federal Laws. <br /> Date 1 1 <br /> APPLICANT'S SIGNATURE: <br /> Paid Pail ! <br /> Program Records to be TRANSFERED: '$25.00= Amount Date <br /> 1 <br /> Water System to be TRANSFERED: Amount Paid <br /> Check Number Received by <br /> Payment Type Date 1 1 <br /> EHD Staff: Date 1 1 Account out: <br /> COMMENTS: <br /> Invoice#: <br />