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Dat <br /> FRwby <br /> 3/19/2015 10:57:59AISAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report k5021 <br /> Facility Information as of 3/19/2015 Pagel <br /> Record Selection Criteria: Fadlity ID FA0010766 <br /> Make changestcorrections in RED Ink. <br /> INFORMATION CHANGE(date) Nr'll Zom <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 <br /> SSN/Fed Tax ID <br /> Owner ID <br /> OW0008766 Case Number: H08684 New Owner ID <br /> Owner Name DAVID RAY <br /> Owner DBA SPECIALIZED TRUCK SVC <br /> Owner Address 3665 E CHEROKEE RD <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-462-5078 <br /> Mailing Address PO BOX 8403 <br /> STOCKTON, CA 952080403 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010766 10183801 <br /> Facility Name SPECIALIZED TRUCK SVC <br /> Location 3665 E CHEROKEE RD <br /> STOCKTON, CA 95205 <br /> Phone 209-462-5078 / r <br /> Mailing Address PO BOX 8403VL Alzu I/ <br /> STOCKTON, CA 952080403 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 002-MILLER, KATHERINE Fax <br /> APN 13206009 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 AR0017766 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SPECIALIZED TRUCK SVC (Circle One) <br /> Account Balance as of 3/19/2015: $0.00 4 ,�� c ( Q �e 1NU 2(0'1710 <br /> C� �"�� (Circle One) <br /> Transfer to Activelinadve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520476 EE0008709-JAMIE DE LA ROSA Active Y N As D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513054 EE0000000-HAZ MAT SJC IDES Inactive Y N A �t D <br /> 2227-GEN 5<25 TONS PERMIT PRO514409 EE0009488-JEFFREY WONG Active Y N A �.\4 D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510766 EE0000000-HAZ MAT SJC DES Inactivr Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528794 EE0009488-JEFFREY WONG Inactive Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PRO522961 EE0009488-JEFFREY WONG Inactive Y N A 1 O <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532118 Inactivr Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent d same,acknowledge that all site,anNor projed specific,PHSEHD hourly charges associated with this facility <br /> or activitywill be billed to me Party identified as the OWNER on this form. l also certify that all operations will be performed in accordance with all applicable Ordinance Codes ander Standards and State ander <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 Type Check Number Receivd y <br /> i <br /> REHS: / Date /.�lJ L/mss Account out: <br /> 1 Date <br /> COMMENTS- <br /> O r(r T-1 G� '�t.0 t/ <br /> r�D✓.-.Y fd /bz�f �`�/PiL. �Q i' <br />