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Datr tL:e 7/14/2015 8:03:53Ah SAN JO�JIN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Report ll Run by Pagel Facility Information as of 7/14/2015 Record Selection Criteria: Facility ID FA0009638 Make changeslcorrections In RED ink. INFORMATION CHANGE(date) OWNERSHIP CHANGE(date) OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID Owner ID OW0007638 Case Number: H05038 New Owner ID Owner Name TONY TERESI Owner DBA DIAMOND TRUCK BODY CO Owner Address 1908 E FREMONT ST STOCKTON, CA 95205 Home Phone Not Specified Work/Business Phone 209-943-1655 Mailing Address 1908 E FREMONT ST STOCKTON, CA 95205 Care of FACILITY FILE INFORMATION Facility ID/CERS ID FA0009638 10182817 Facility Name DIAMOND TRUCK BODY CO Location 1908 E FREMONT ST STOCKTON, CA 95205 Phone 209-943-1655 x Mailing Address 1908 E FREMONT ST STOCKTON, CA 95205 Care of mike wutzke Location Code 01 -STOCKTON Alt Phone Bos District 001 -VILLAPUDUA, CARLOS Fax APN 15308014 EMail: EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0016638 New Account ID: Mail Invoices to Account Mail Invoices to: Owner / Facility I Account Account Name DIAMOND TRUCK BODY CO (circle One) Account Balance as of 7/14/2015: $0.00 (Cirde One) Transferto Active/Inactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1921 -HMBP-Regular-Primary Location PR0519792 EE0000006-HAZA SAEED Active Y N A I D 2220-SM HW GEN<5 TONS/YR PRO513942 EE0000027-CINDY VO Active Y N A I D 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511926 EE0000000-HAZ MAT SJC DES Inactive Y N A I D 2226-CalARP PROGRAM PR0514617 EE00o0000-HAZ MAT SJC OES Inactive Y N A I D 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509638 EE0000000-HAZ MAT SJC DES Inactive Y N A 1 D ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534104 Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHS/EHD hourly charges associated with this facility 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 andor Standards and State ands Federal Laws. APPLICANTS SIGNATURE: Date Program Records to be TRANSFERED: "$25.00= Amount Paid Date Water System to be TRANSFERED: Amount Paid Date / / Payment Type Check Number Received by EHD Staff: Dale / / Account out: Date COMMENTS: Invoice ir.