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Date run 2/16/2016 3:00:36PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 2/16/2016 <br />Record Selection Criteria: Facility ID FA0004959 <br />G Ind N Ij eCl� a S p e r- r -e- 4 u wt.J w�q <br />Make changes/corrections in RED ink. <br />INFORMATION <br />CHANGE (date) <br />OWNERSHIP <br />CHANGE (date) <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN /Fed Tax ID <br />Owner ID OW0014626 <br />New Owner ID <br />Owner Name mansoor karimi <br />Owner DBA <br />Owner Address 2111 CABANA LN <br />TRACY, CA 95377 <br />Home Phone 209-640-0394 <br />Work/Business Phone 209-463-9400 <br />Mailing Address g <br />00 0 V <br />stcicktop, CA 95n6 <br />�-nGk-�'or� <br />C� 5 <br />Care of KARIMI, MANSOOR <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0004959 10181699 <br />Facility Name TRI VALLEY AUTO DISMANTLERS <br />Location 930 E DR MARTIN LUTHER KING JR BLVC <br />STOCKTON, CA 95206 <br />Phone 209-463-9500 x <br />Mailing Address 93 <br />d C9 C) CC) <br />SUW*tGn -x-95-2-06 <br />o c- [L+o Q <br />C—A q <br />S aD S — � (3 ,� <br />Care of mansoor karimi <br />Location Code 01 - STOCKTON <br />Alt Phone <br />BOS District 001 - VILLAPUDUA, CARLOS <br />Fax <br />APN 16718303 <br />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 AR0005401 <br />New Account ID: <br />Mail Invoices to Facility <br />Mail Invoices to: <br />Owner / <br />Facility / Account <br />Account Name TRI VALLEY AUTO DISMANTLERS <br />(Circle One) <br />Account Balance as of 2/16/2016: $1,792.50 <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID <br />Employee ID and Name <br />Status <br />New Owner? Delete <br />1920 - HMBP-Common Materials PR0521105 <br />EE0009817 - ROBERT LOPEZ <br />Active <br />Y N A I D <br />2217 -APPLIANCE RECYCLER PR0521509 <br />EE0001421 -STACY RIVERA <br />InactivE <br />Y N A I D <br />2220 - SM HW GEN <5 TONS/YR PR0517682 <br />EE0001421 - STACY RIVERA <br />Active <br />Y N A I D <br />2220 - SM HW GEN <5 TONS/YR PR0521746 <br />EE0001421 -STACY RIVERA <br />InactivE <br />Y N A I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0517681 <br />EE0000000 - HAZ MAT SJC OES <br />InactivE <br />Y N A I D <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0500994 <br />EE0000008 - LETITIA BRIGGS <br />InactivE <br />Y N A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PR0517683 <br />EE0000008 - LETITIA BRIGGS <br />InactivE <br />Y N A I D <br />4740 - WASTE TIRE SITE - EXEMPT PR0523946 <br />EE0002622 - BENJAMIN ESCOTTO <br />Active <br />Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0534579 <br />InactivE <br />Y N A I D <br />G Ind N Ij eCl� a S p e r- r -e- 4 u wt.J w�q <br />