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Date run 1/25/2013 4:45:51PR SAN JOilialeVINCOUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/25/2013 <br /> Record Selection Criteria: Facility ID FA0020532 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0016874 New Owner ID <br /> Owner Name PARMINDER BINNING <br /> Owner DBA AJ AUTO N EXPRESS LUBE <br /> Owner Address 428 N AIRPORT WAY <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-451-1699 <br /> Mailing Address 428 N AIRPORT WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0020532Q ✓� <br /> Facility Name AJ AUTO N EXPRESS LUBE <br /> Location 428 N AIRPORT WAY <br /> STOCKTON, CA 95205 <br /> Phone 209-451-1699 x0 <br /> Mailing Address 428 N AIRPORT WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 15113054 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 AR0036736 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name PARMINDER BINNING (Circle One) <br /> Account Balance as of 1/25/2013: $0.00 '2, <br /> (Circle One) <br /> Transfer to Adive�lnadve <br /> PrograMElement and Description Record ID Employee ID and Name S a New Owner? Delete <br /> 1920-HMBP-Common Materials PR0535608 EE0006044-LOWELL ALLEN Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PR0535996 Ive Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anclor 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 Caries andfor Standards and State ar4or <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 Receil <br /> REHS: Date Z Account out: Date <br /> COMMENTS: <br /> b2 QUVt- <br />