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Date run 9/26/2018 4:45:55PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/26/2018 <br /> Record Selection Criteria: Facility ID FA0020704 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) It <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 <br /> Owner DBA K1NG LLC <br /> Owner Address ,^rvr wC�� ,�—�—�,y � ��� tA 421 <br /> &T0e TOT CA-952e3-- ©<<k� ��. c /4 s-3 i, <br /> Home Phone 800-825-1205 Z4 - -2-(.7 7S <br /> Work/Business Phone 800-825-1205 0C1 2tto 7S- <br /> Mailing Address VE Ct 0i L4 , L1 <br /> s <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0020704 10187679 <br /> Facility Name KEEP ON TRUCKING LLC, F;vx wl,Q c.__ -e -A 4 <br /> Location 808 SNEDEKER AVE <br /> STOCKTON, CA 95203 <br /> Phone .29 38-97��2_ 4-loly-333.1 <br /> Mailing Address 1015 FYFFE AVE <br /> Stockton, CA 95203 <br /> Care of par+y LLG. G <br /> Location Code 01 - STOCKTON It 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 /> L <br /> Account ID AR0037121 t I © New Account ID: <br /> Mail Invoices to Facility - Rlrail Invoices to: Owner / Facility / Account <br /> Account Name K -LLC �� LI (Circle One) <br /> Account Balance as of 9/26/2018: $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 Inactive Y N I D <br /> 2220-SM HW GEN<5 TONS/YR PR0538623 EE0001421 -1TACY RIVERA Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0536031 EE0009000-HARPRIT MATTU Inactive Y N 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,andror 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 Type Check Number Received by <br /> EHD Staff: Date / Z lu/ Account out: Date <br /> COMMENTS: 3i 5:>5� <br /> Invoice#: <br />