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Date run 8/24/2016 4:33:27Ph SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 8/24/2016 Pagel <br /> Record selection Criteria: Facility ID FA0015913 <br /> Make changes/corrections in RED ink. p / <br /> INFORMATION CHANGE(date) b <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0020956 New Owner ID <br /> Owner Name GARCHA, JASVIR <br /> Owner DBA <br /> OwnerAddress 1501 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1501 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0015913 <br /> Facility Name GARCHA TIRES & REPAIR <br /> Location 1501 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-215-4000 <br /> Mailing Address 1501 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> care of GARCHA, JASUIR <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOIS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 16337016 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 AR0027682 New Account ID: <br /> Mail lnvoicesto Facility Mail a <br /> Invoices to: Owner / Facility / Account <br /> Account Name GARCHA TIRES & REPAIR (Circle One) <br /> Account Balance as of 8/24/2016: $0.00S Gimle One) <br /> nacove <br /> Program/Element and Description Record ID Employee ID and Name Status Transferee ActlDelete <br /> New Owner? Delete Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0527156 EE0009817-ROBERT LOPEZ Inactive Y N' A/I D <br /> 2220-SM HW GEN<5 TONS/YR PRO540911 EE9999998-ONE VACANT1 Active Y N I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523572 EE0009000-HARPRIT MATTU Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0533707 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor protect specific,PHS/EHD hourly charges associated with this facility, <br /> or activity will be billed to the party identified as the OWNER on this Tann. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor 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 <br /> Payment Typ Check Number Received b <br /> EHD Staff: Date / / Account out: _ Date_g/1/ 10 <br /> COMMENTS: <br /> �O LA—" f � f tAA ( Invoice#: <br /> rCQIS CL �tl <br /> � f VVI .2 P <br /> I ✓� Sp zC- <br />