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Dwe mn 5/22/2014 1:11:31 Ph SAN J UIN COUNTY ENVIRONMENTAL HEAA DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/22/2014 <br /> Record Selection Criteria: Facility ID FA0014396 <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 OW0011438 New Owner ID <br /> Owner Name AutoZone Stores Inc <br /> Owner DBA AUTO ZONE#3335 <br /> Owner Address 123 S FRONT ST <br /> MEMPHIS, TN 38103 <br /> Home Phone Not Specified <br /> Work/Business Phone 901-495-6500 <br /> Mailing Address 123 South Front Street <br /> Memphis, TN 38103 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0014396 10140033 <br /> Facility Name AutoZone#3335 <br /> Location 147 S Main St <br /> Manteca, CA 95336 <br /> Phone 209-824-9665 x <br /> Mailing Address Dept 8190, 123 South Front Street <br /> Memphis, TN 38103 <br /> Care of Alfonso Franco <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0024476 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name AutoZone Stores Inc (Circle One) <br /> Account Balance as of 5/22/2014: $0.00 <br /> (Circle One) <br /> Transfer to Activelinactve <br /> Progra"Element and Description Record ID Employee In and Name Status New Omer? Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO519254 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0521331 EE0005642-MICHELLE HENRY Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534284 Inactivs Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project speciFc,PHSIEHD 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 anNor Standards and State amVor <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 Reoe y „I <br /> REHS: Date_/ / Account out: Date <br /> COMMENTS: v� <br />