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Date run 11/2/2017 3:28:35PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11I2I2017 <br /> Record Selection Cntena: Facility ID FA0009745 <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 SSN/Fed Tax ID <br /> Owner ID OW0007745 Case Number: H05317 New Owner ID <br /> Owner Name WEGAT, HOWARD JR <br /> Owner DBA WEGATS TRUCK REPAIR <br /> OwnerAddress 23192 N DUSTIN RD <br /> ACAMPO, CA 95220 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-334-1744 <br /> Mailing Address PO BOX 261 <br /> ACAMPO, CA 95220 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009745 10182857 <br /> Facility Name WEGATS TRUCK REPAIR <br /> Location 23192 N DUSTIN RD <br /> ACAMPO, CA 95220 <br /> Phone 209-334-1744 x <br /> Mailing Address PO BOX 261 <br /> ACAMPO, CA 95220 <br /> Care of HOWARD WEGAT JR. <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 00705032 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016745 New Account ID: <br /> Mail Invoices to AcsQUnt Mail Invoices to: Owner / Facility / Account I I�,/1 <br /> Account Name WEGA UCK REPAIR n ccirclaOn.) [fl• f� <br /> Account Balance as of 11/2/2017: $455-0Q, <br /> r <br /> (Circe One) <br /> Transfer to Acive/lnactve <br /> Program/Element and Descrption Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PRO519842 EE0008709-JAMIE LIMA Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PR0514017 EE0000030-AARON HANG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO612033 EE0000000-HAZ MAT SJC DES Inactive Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509745 EE0o00000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532723 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of acme,acknowledge that all site,andior project specdic,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as me OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anNor Standards and State anG'or <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 b p <br /> EHD Staff: Date / Account out: Date / 7 / 1-7 <br /> COMMENTS: <br /> Invoice#: <br />