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:. <br /> Diets run 5/22/2014 1:10:38PR SAN J UIN COUNTY ENVIRONMENTAL HEAMH 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 AUTO ZONE 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 S FRONT ST <br /> MEMPHIS, TN 38103 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0014396 10140033 <br /> Facility Name AUTO ZONE#3335 <br /> Location 147 S MAIN ST <br /> MANTECA, CA 95336 <br /> Phone 209-824-9665 x0 <br /> Mailing Address 123 S FRONT ST <br /> MEMPHIS, TN 38103 <br /> Care of <br /> Location Code Alt Phone <br /> BOB District Fax <br /> APN 21941014 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 /> Maillnvoicesto Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name AUTO ZONE INC (Circle One) <br /> Account Balance as of 5/22/2014: $0.00 <br /> (Circle One) <br /> Transfer to Acgv&lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519254 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO521331 EE0005642-MICHELLE HENRY Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534284 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project speck,PHS1EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form 1 also certify that all operations will be performed in accordance with all applicable Ordinance Codes an/or 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 Recei d <br /> REHS: Date / / Account out: Date I / <br /> COMMENTS: <br />