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Repos#5021 <br /> EDaWwn ;2/1312;015 10:56:28AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Pagel <br /> Facility Information as of 2/13/2015 <br /> 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 Owner ID <br /> Owner Name JANOFSKY, JON <br /> Owner DBA RMB GARAGE <br /> Owner Address 715 N HUNTER ST <br /> STOCKTON, CA 952021704 <br /> Home Phone 209-785-3210 <br /> Work/Business Phone 209-467-4431 <br /> Mailing Address <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010223 10183339 <br /> Facility Name RMB GARAGE <br /> Location 715 N HUNTER ST <br /> STOCKTON, CA 95202-1720 <br /> Phone 209-467-4431 x / <br /> Mailing Address .74 6 111 1 n to Too ST-A" <br /> yk�n� A S2�Elo-016 �' <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) <br /> Account Balance as of 2/13/2015: $453.00 <br /> (Circle One) <br /> Thirster to Aawaractve <br /> Program/Element and Description Recon 10 Employee ID and Name Status New OwneO Delete <br /> 1920-HMBP-Common Materials PRO520157 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514237 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512511 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510223 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533694 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT-. 1,the undersigned Dern.,,operator ar agent of same,acknowledge that ell site,andor project specific,PHSrEHD hourly charges asecasod vin Nis facility <br /> or activity will be billed to the pony identified as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes endor Standard.and State ander <br /> Federal Laws. /� n.. t�.�/r 1 <br /> APPLICANT'S SIGNATURE: 1" r ipr [L I�70(- 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 Rece�if d�b <br /> REHS: Date_/ / Account out: I L, <br /> COMMENTS: <br />