Laserfiche WebLink
Dme nr;n3/9;/2017 1:45:40PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENTRun by Report#5021 <br /> Facility Information as of 3/9/2017P'se' <br /> Recorda: Facility ID FA0010264 <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 <br /> SSN/Fed Tax ID <br /> Owner ID OW0008264 Case Number: H07525 New Owner ID <br /> Owner Name Lithia Motors <br /> Owner DBA <br /> Owner Address 150 N BARTLETT CIR <br /> MEDFORD, OR 92501 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-955-3181 <br /> Mailing Address 150 N Bartlett St <br /> Medford, OR 97501 <br /> Care of LITHIA AUTO STORES <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010264 10183381 <br /> Facility Name Volkswagen of Stockton <br /> Location 2991 AUTO CENTER CIR <br /> STOCKTON, CA 95212 <br /> Phone 209-242-9700 x <br /> Mailing Address 2991 AUTO CENTER CIR <br /> STOCKTON, CA 95212 <br /> Care of Volkswagen of Stockton <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOB District 003- BESTOLARIDES, STEVE Fax <br /> APN 12802017 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 AR0017264 New Account ID. <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Volkswagentockton `- (circle one) <br /> Account Balance as of 3/9/2017: $5 .00 ,^}` <br /> V� (Circle One) <br /> Transfer to Adh,s?Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New OwneR Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520181 EE0008709-JAMIE LIMA Active Y N A D <br /> 2220-SM HW GEN<5 TONS/YR PR0514259 EE0001459-VICKI MCCARTNEY Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512552 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO510264 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528219 EE0000006-HAZA SAEED Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO522827 EE0009000-HARPRIT MATTU Inactive Y N A 1 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE PR0534262 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent M same,acknowledge that all site,andor 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 certRy that ail operations will be performed in accordance with all applicable Ordinance Codes andor Standards antl State andor <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 Received by <br /> EHD Staff: �\1M OI.i Date / _/1� Account out: lj!-�, Date �✓- l I �J/ 1-7 <br /> WNb <br /> Vho urger th oy�eraL�ilem a+ his ae�S . <br /> Invoice#: <br />