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Dale run 8/4/2014 2:21:12PM SAN X UIN COUNTY ENVIRONMENTAL HEA A DEPARTMENT Report#5021 <br /> Run by *W Pagel <br /> Facility Information as of 8/4/2014 <br /> Record Selection Criteria. Facility ID FA0010933 <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 OW0008933 Case Number: H08999 New Owner ID <br /> Owner Name OSORIO, HECTOR <br /> Owner DBA CONTINENTAL MUFFLER <br /> Owner Address 230 E LODI <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 230 E LODI AVE <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010933 10183945 <br /> Facility Name CONTINENTAL MUFFLER <br /> Location 230 E LODI AVE <br /> LODI, CA 95240 <br /> Phone 209-368-1360 x0 <br /> Mailing Address 230 E LODI AVE <br /> LODI, CA 95240 <br /> Care of <br /> Location Code 02 - LODI Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 04719129 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 AR0017933 NewAccount ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name OSORIO, HECTOR (CIr'deOna) <br /> Account Balance as of 8/4/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> ProgranyElement and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 1920-HMBP-Common Materials PR0520868 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514460 EE0001422-ARIS VELOSO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513221 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510933 EEOOO0000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532307 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowletlge that all site,andar protect spec,PHSrEHD 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 andor Standards and State andor <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 by <br /> REHS: Date / / Account out: Date I / <br /> COMMENTS: <br />