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late ran 4/21/2015 3:24:53PN SAN KWIN COUNTY ENVIRONMENTAL HEA*DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/21/2015 <br /> Record Selection Criteria: Facility ID FA0021712 <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: 10 SSN/Fed Tax ID : <br /> Owner ID OW0000531 New Owner ID <br /> Owner Name DOLGEN CALIFORNIA, LLC <br /> Owner DBA DOLLAR GENERAL <br /> Owner Address 100 MISSION RIDGE <br /> GOODLETTSVILLE, TN 370722171 <br /> Home Phone 615-855-4781 <br /> Work/Business Phone 615-855-4024 <br /> Mailing Address 100 MISSION RIDGE 1 <br /> GOODLETTSVILLE, TN 37072 <br /> Care of ATTN: TAX DEPT <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0021712 10413154 <br /> Facility Name Dollar General#14353 <br /> Location 915 E Yosemite Ave <br /> Manteca, CA 95336 <br /> Phone 209-275-1377 x <br /> Mailing Address 100 MISSION RIDGE <br /> GOODLETTSVILLE, TN 37072 <br /> Care of DOLLAR GENERAL#14353 <br /> Location Code 04 - MANTECA Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ATTN: TAX DEPT <br /> Title <br /> Day Phone 615-855-4796 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039414 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ERIC VOYLES (Circle One) <br /> Account Balance as of 4/21/2015: $0.00 <br /> (Clyde One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1618-RETAIL MKT>2000 SQ FT (PREPKGD/LTD PRE PR0537686 EE0004589-KADEANNE LINHARES Active Y N A I D - <br /> 1921 -HMBP-Regular-Primary Location PR0539164 EE0002474-MICHAEL PARISSI Active Y N A QI D <br /> 2220-SM HW GEN<5 TONS/YR PRO537831 EE0001421 -STACY RIVERA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned ovmer,operator or agent of same,acknowledge that all site,andbr project specific,PHSIEHD 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 andfor Standards and State andfor <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 Receive <br /> RENS: \4 -ii_ .. til - Dated/ 'i\ / _ Account out: Date <br /> COMMENTS: <br />