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Date run 1/29/2014 10:38:58A1 SAN JC. JIN COUNTY ENVIRONMENTAL HEAI DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/29/2014 <br /> Record Selection Criteria: Facility ID FA0017558 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014399 New : <br /> Owner Name -D d 4G+4A Mn� 1 0 e g •" +'Ai <br /> Owner DBA ZALWJ09MA-&IJ-T ) cam.-.�°r � <br /> Owner Address 527 N WILSON WAY <br /> STOCKTON, CA 95205 --- <br /> Home Phone Not Specified ° - <br /> Work/Business Phone 209-547-9971 <br /> Mailing Address 527 N WILSON WAY <br /> Care of STOCKTON, CA 95205 VICTORY <br /> AUTO SALEs <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0017558 e a aespano I r <br /> w.,.. <br /> Facility Name CALIFORNIA AUTO SALES <br /> Location 1301 E MINER AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-547-9971 x0 <br /> Mailing Address 527 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of <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 AR0030440 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name D J JOHAL (Circle One) <br /> Account Balance as of 1/29/2014: $0.00 <br /> (Circle One) <br /> Tran erto ActivellnacNe <br /> PrograMElement and Description Record ID Employee ID and Name Status New O er7 Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0525743 Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533766 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. 1,the undersigned owner,operalororagent of same,acknowledge that all site,andlor project sp c,PHS/EHDhoudychar 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 applicabl Ninance Codes e r Stantlartls and State anNor <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 /> RENS: Date_/ / Account out: Date <br /> COMMENTS: rr / <br /> tn/Q,y'�Ml-� � �r t 1AIZ, (3 <br /> w 4b <br /> 014 Cars `�Iti� �� ( � / r jsc <br /> L'1v�v�h <br /> la P A<� a✓� fC2� C t7 Int `�✓ 5�1° ��. /�//d <br />