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Date run 12!2812016 8:45:12A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTS <br /> Run by DEPARTMENT NT Report#5021 <br /> Facility Information as of 12/28/2016 Pagel <br /> Record Selection Criteria: Facility ID FA0009927 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 OWNERSHIP CHANGE(date) 1Z-Z \ <br /> SSN 1 Fed Tax ID <br /> Owner 1D OW0020241 New Owner ID <br /> Owner Name TRANS AMERICAN INC <br /> Owner DBA <br /> Owner Address 2008 JAVELINE DR <br /> LA PORTE, IN 46350 <br /> Home Phone 219-898-8414 <br /> Work/Business Phone 219-210-8070 <br /> Mailing Address 2008 JAVELINE DR <br /> LA PORTE, IN 46350 <br /> Care of CLARK, JAMES & ELISA <br /> FACILITY FILE INFORMATION <br /> Facility ID!CERS ID FA0009927 10183037 <br /> Facility Name TRANS AMERICAN INC <br /> Location 1838 VICKI LN <br /> STOCKTON, CA 95205 <br /> Phone 219-210-8070 <br /> Mailing Address 2008 JAAVELINE DR <br /> LA PORTE, IN 46350 <br /> Care of CLARK, JAMES & ELISA <br /> Location Code 01 - STOCKTON Alt Phone <br /> BGS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 14109023 EMail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JAMES & ELISA CLARK <br /> Title <br /> Day Phone 219-210-8070 <br /> Night Phone 219-898-8414 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016927 New Account ID: <br /> Mail Invoices to Account Mail Invoices to Owner / Facility / Account <br /> Account Name TRANS AMERICAN INC (Circle One) <br /> Account Balance as of 12/28/20116: $0.00 <br /> (Circle one) <br /> Transfer to Activefinacive <br /> Program/Element and Description Record ID Employee ID and Name Status Naw(1-0 Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520893 EE0000006-HAZA SAEED Active Y N I D <br /> 2220-SM HW GEN<5 TONSNR PR0529778 EE0009488-JEFFREY WONG InaCtIVE Y N I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512215 EE0000000-HAZ MAT SJC OES InactivE Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FE PR0509927 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE PR0531317 InactivE Y N A I D <br /> BILLVNG and COMPLIANCE ACKNOWLEDGEMENT. I.the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this <br /> facility 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 andlor Standards <br /> and State anclior Federal Laws. <br /> APPLICANT'S SIGNATURE- Date 1 f <br /> Program Records to be TRANSFERED' `$25.00= Amount Paid Date / ! <br /> Water System to be TRANSFERED: Amount Paid Date I 1 <br /> Payment Type Check Number Received lo <br /> EHD Staff Date Date .— 1_"cni 1� Account out 1% Date <br /> COMMENTS <br /> Tl Cl Vj- >Zc���e C�'UY,3 �iVc 5 - InVOIGe#: <br />