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Date run 2/19/:015 10:25:24AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/19/2015 <br /> Record Selection Criteria: Facility ID FA0020704 <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/Fed Tax ID <br /> Owner ID OW0017013 New Owner ID <br /> Owner Name Keep On Trucking Company LLC <br /> Owner DBA KEEP ON TRUCKING LLC <br /> Owner Address 705 CAVANAUGH AVE <br /> STOCKTON, CA 95203 <br /> Home Phone 800-825-1205 <br /> Work/Business Phone 800-825-1205 <br /> Mailing Address PO BOX 3209 <br /> RANCHO CUCAMONGA, CA 91729 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0020704 10187679 <br /> Facility Name KEEP ON TRUCKING LLC <br /> Location 808 SNEDEKER AVE <br /> STOCKTON, CA 95203 <br /> Phone 209-938-0750 x2202 <br /> Mailing Address 705 Cavanaugh Ave <br /> Stockton, CA 95203 <br /> Care of Keep On Trucking Company LLC <br /> Location Code 01 -STOCKTON Aft Phone <br /> BOS District 003- BESTOLARIDES, STEVE Fax <br /> APN 16203007 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0037121 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name KEEP ON TRUCKING LLC (Cirde One) <br /> Account Balance as of 2/19/2015: $563.00 <br /> (Circle One) <br /> Transfer to Activellnadve <br /> Program/Elemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0535945 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0538623 EE0001421 -STACY RIVERA Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0536031 EE0009000-HARPRIT MATTU Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0535976 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,anclor protect specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on thisform. Iall certity that all operations will be Performed in accordance with all applicable Ordnance Codes andor Standards and State ands <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <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 by <br /> RENS: Date / / Account out: Date <br /> COMMENTS: <br />