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r <br /> Date run 12/26/2014 1:29:43F SAN JOA,.�IN COUNTY ENVIRONMENTAL HEAL I...wDEPARTMENT Report#5021 <br /> Pagel <br /> Run by <br /> Facility Information as of 12/26/2014 <br /> Record Selection Criteria: Facility ID FA0010223 <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 OW0008223 Case Number: H07381 New Ownpr : <br /> Owner Name JANOFSKY, JON 1A ( <br /> Owner DBA RMB GARAGE 1 / t/ e r k 1 1CV14t-C S <br /> Owner Address 715 N HUNTER ST t ' <br /> STOCKTON, CA 952021704 _ <br /> Home Phone 209_786_3,240— <br /> Work/Business Phone 209.467443t—" <br /> Mailing Address 715 N HUNTER ST#A t <br /> STOCKTON, CA 95202-1704 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010223 10183339 <br /> Facility Name RMB-G-ARA ,( <br /> Location 715 N HUNTER ST <br /> STOCKTON, CA 95202-1720 <br /> Phone 2 <br /> Mailing Address 7115 N HUNTER ST#A _ <br /> STOCKTON, CA 95202-1704 <br /> Care of Alice Gonzales <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 13905409 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 AR0017223 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name JANOFSKY, JON (Circle One) 1 <br /> Account Balance as of 12/26/2014: $0.00 / fLf.Q l ° W,� cd;A-e- <br /> 1 / l S C (Circle One) <br /> r / + Transfer to Active/Inactve <br /> Program/Element and Description j-� ~ t Record ID Employee ID and Name / ^ Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0520157 EE0009817-ROBERT LOPEZ ( Zf`�Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PR0514237 EE0009488-JEFFREY WONG Active Y N A F,-�i D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512511 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510223 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533694 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD 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 performed in accordance with all applicable Ordinance Codes and/or Standards and State andror <br /> Federal Laws. ' <br /> APPLICANT'S SIGNATURE: Date / ! <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date t (2:3 <br /> Water System to be TRANSFERED: Amount Paid Date / ! <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: L/17 Date 3 /--J2 <br /> !�S <br /> COMMENTS: <br />