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Date run 9/23/2015 12:15:07P1 SAN J(1`IUIN COUNTY ENVIRONMENTAL HEF_ �I DEPARTMENT Pagel <br /> Report#5021 <br /> Run by v <br /> Facility Information as of 9/23/2015 <br /> Record Selection Criteria: Facility ID FA0016240 <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 OW0013134 New Owner ID <br /> Owner Name Sukhjeven Singh <br /> Owner DBA <br /> Owner Address 3701 W LINNE RD <br /> TRACY, CA 95304 <br /> Home Phone 209-688-4801 <br /> Work/Business Phone 209-836-9463 <br /> Mailing Address 28644 S Tracy Blvd <br /> TRACY, CA 95378 <br /> Care of SINGH, SUKHJEREN <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0016240 10185137 <br /> Facility Name ABT Freight Lines <br /> Location 28644 S TRACY BLVD <br /> TRACY, CA 95378 <br /> Phone 209-836-9463 x <br /> Mailing Address 28644 S TRACY BLVD <br /> TRACY, CA 95378 <br /> Care of Sukhjeven Singh <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 25312033 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 AR0028403 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ABT Freight Lines (circle One) <br /> Account Balance as of 9/23/2015: $0.00 <br /> (Circle One) <br /> Transfer to Activerinaclve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO539045 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PRO524189 EE0002646-THUY TRAN Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO527074 EE0009000-HARPRIT MATTU Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532074 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anwor project specific,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the parry identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andfor Standards and State andor <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 I / <br /> Payment Type Check Number Received by <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> Invoice#: <br />