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Date run 11/21/2016 9:07:OOA SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/21/2016 <br /> Record Selection Criteria: Facility ID FA0020704 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) /—Z <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 I 0 1 S' I—u Av . <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 ID/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 4 j E u -E T -L <br /> Stockton, CA 95203 <br /> Care of Keep On Trucking Company LLC <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 16203007 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 AR0037121 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name KEEP ON TRUCKING LLC (Circle One) <br /> Account Balance as of 11/21/2016: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0535945 EE0009817-ROBERT LOPEZ Active Y N A 0 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 SURCHARGI PR0535976 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD 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 and/or Standards and State and'or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Typ Check Number Received by <br /> EHD Staff: t��L Date I I / Z.F/ G" Account out: Date y l� <br /> COMMENTS: <br /> ; r lnV IOe#: <br /> I t, ti � -�"s 0�� w tJ z-f L i n S/0 2 - -_ ,'o 0 It`2 <br />