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Date run 12/16/2014 9:30:24A SAN IN COUNTY ENVIRONMENTAL E `DEPARTMENT Report#5021 <br /> Run by �� Ir %W- . Pagel <br /> Facility Information as of 12/16/2014 <br /> Record Selection Criteria: Facility ID FA0011268 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID : <br /> Owner ID OW0009268 Case Number: H09543 New Owner ID : <br /> Owner Name LESHER, GARY <br /> Owner DBA DONS MUFFLER & BRAKE SVC <br /> Owner Address 26 N CHEROKEE LN <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-334-2902 <br /> Mailing Address PO BOX 1433 <br /> LODI, CA 95241 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0011268 10184133 <br /> Facility Name DONS MUFFLER & BRAKE SVC <br /> Location 26 N CHEROKEE LN <br /> LODI, CA 95240 <br /> Phone 209-334-2902 x <br /> Mailing Address PO BOX 1433 <br /> LODI, CA 95241 <br /> Care of Gary Lesher <br /> Location Code 02 - LODI Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 04321027 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 AR0018268 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name LESHER, GARY (Circle One) <br /> Account Balance as of 12/16/2014: $0.00 <br /> (Circe One) <br /> Transfer to Active/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status New OwneO Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520794 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513556 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0511268 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532333 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner operator or agent of same,acknowledge that all site,ander 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 Codes ander Standards and State ander <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 T Check Number ��" Recei <br /> REHS: Q ( Date / tru / Account out: Date <br /> COMMENTS. <br /> &Sij USS <br /> g12Vt q . A)O OC.ce.�QS kff- dowe i nspearl <br />