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Date run 9/11/2014 4:35:16PR <br /> SAN JOAMN COUNTY ENVIRONMENTAL HEAL-#PEPARTMENT Report*5021 <br /> Run by Pagel <br /> Facility Information as of 9/11/2014 <br /> Record Selection Criteria: Facility ID FA0013395 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSKI Fed Tax ID <br /> Owner ID OW0010532 New Owner ID <br /> Owner Name GUZMAN, ANTONIO <br /> Owner DBA ANTONIOS MUFFLERS <br /> Owner Address 1810 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-547-9540 <br /> Mailing Address 1810 E MAIN ST <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID f CERS 1D FA0013395 10184357 <br /> Facility Name ANTONIOS MUFFLERS <br /> Location 1810 E MAIN ST <br /> STOCKTON, CA 95205 <br /> Phone 209-547-9540 <br /> Mailing Address 1810 E MAIN ST <br /> STOCKTON, CA 95205 <br /> Care of GUZMAN, ANTONIO <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 15522013 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GUZMAN, ANTONIO <br /> Title <br /> Day Phone 209-547-9540 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022323 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name ANTONIOS MUFFLERS (Circle One) <br /> Account Balance as of 9/11/2014: $0.00 <br /> (Circle One) <br /> Transfer to Activerinactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO521146 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO517390 EE0009488-JEFFREY WONG Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO517563 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO517391 EE0000008-LETITIA(BRIGGS Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533329 Inactive Y N A 1 0 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific,PHSIEHD hourly charges associated with this facility <br /> or activity wily 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 andtor Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFER€D: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> REHS: Date f f Account out: Date 1 1 <br /> COMMENTS: <br />