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s , <br /> Date run 11/30/2015 8:28:53A SAN 3%',QUIN COUNTY ENVIRONMENTAL HEQ'H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/30/2015 <br /> Record Selection Criteria: Facility 10 FA0020757 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN 1 Fed Tax ID <br /> Owner ID OW0013420 New Owner ID <br /> Owner Name TAYLOR, ROBERT B <br /> Owner DBA TAYLOR AUTOMOTIVE <br /> OwnerAddress 3373 HEATHERBROOK DR <br /> STOCKTON, CA 95219 <br /> Home Phone 209-931-6007 <br /> WOrWBusineSs Phone 209-227-5077 <br /> Mailing Address 3373 HEATHERBROOK DR. <br /> STOCKTON, CA 95219 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID!CERS ID FA0020757 10187687 <br /> Facility Name TAYLOR AUTOMOTIVE INC <br /> Location 3932 E FREMONT ST <br /> STOCKTON, CA 95215 <br /> Phone 209-931-6007 x <br /> Mailing Address 3932 E FREMONT ST <br /> STOCKTON, CA 95215 <br /> Care of TAYLOR, ROBERT B <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 14336004 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 AR0037241 New Account ID: : <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility ! Account <br /> Account Name TAYLOR AUTOMOTIVE INC (Circle One) <br /> Account Balance as of 1113012015: $0.00 <br /> (Circle One) <br /> Transfer to Activednactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PRO536317 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0536125 EE0000027-CINDY VO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0536126 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and+or project specifie,.PHSrEH❑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 a performed in accordance with all applicable Ordinance Codes and'or Standards and State and+or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! 1 <br /> Program Records to be TRANSFEREll "$25.00= Amount Paid Date ! 1 <br /> Water System to be TRANSFERED: Amount Paid Date ! ! <br /> Payment Type Check Number Received by <br /> EHD Staff: Date 1 1 Account out: Date 1 ! <br /> COMMENTS llnvoice#: <br />