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Date run 9/28/2017 9:28:44AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Run by It Report#5021 <br /> Facility Information as of 9/28/2017 Pagel <br /> Record Selection Criteria: Facility ID FA0006281 .. <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: 2 SSN/Fed Tax ID <br /> Owner ID OW0005007 New Owner ID <br /> Owner Name MCCOY TRUCK TIRE SERVICE CENTER <br /> Owner DBA <br /> OwnerAddress 1407 LONE PALM AVE <br /> MODESTO, CA 95351 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1537 EMARKET ST <br /> STOCKTON, CA 95205 <br /> Care of MCCOY TRUCK TIRE SERVICE CENTER <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0006281 <br /> Facility Name MCCOY TRUCK TIRE SERVICE CENTER <br /> Location 1537 E MARKET ST <br /> STOCKTON, CA 95205 <br /> Phone <br /> Mailing Address 1537 EMARKET ST <br /> STOCKTON, CA 95205 <br /> Care of BRINK, PAUL <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District Fax <br /> APN 15502061 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name WILSON WAY TIRE <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0007473 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MCCOY TRUCK TIRE SERVICE CENTER (CirdeOne) <br /> Account Balance as of 9/28/2017: $0.00 <br /> (Circle One) <br /> Program/Element and Description Record ID Employee ID and NameStatus Transferto Activennadve <br /> New Owner? Delete <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO604680 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0524156 EE0004486-ANGELICA SANDOVAL MARII Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor project specific,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 anotor Standards and State anwor <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 Receive 1 <br /> EHD Staff: Date / /_ Account out: Date <br /> COMMENTS: -- <br /> Invoice#: <br />