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Date run ti 6/12/2015 4:00:55PkSAN JC UIN COUNTY ENVIRONMENTAL HEA I DEPARTMENT Repot #5021 <br />Run by Pagel <br />Facility Information as of 6/12/2015 <br />Record Selection Criteria: Facility ID FA0009247 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />Owner ID OW0007247 Case Number: H02373 <br />Owner Name David Garcia <br />Owner DBA B&H TRANSMISSION AUTO CARE <br />Owner Address 3422 E MINER AVE <br />STOCKTON, CA 95205 <br />Home Phone 209-323-5350 <br />Work/Business Phone 209-416-7536 <br />Mailing Address 3422 e miner <br />Stockton, CA 95205 <br />Care of GARCIA, DAVID <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0009247 10182543 <br />Facility Name <br />B&H TRANSMISSION AND AUTO CARE <br />Location <br />3422 E MINER AVE <br />Mail Invoices to Account <br />STOCKTON, CA 95205 <br />Phone <br />209-323-5350 x <br />Mailing Address <br />3422 E. Miner <br />Account Name David Garcia <br />Stockton, CA <br />Care of <br />David Garcia <br />Location Code <br />BOS District <br />APN <br />14339009 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name GARCIA, DAVID <br />Title OWNER <br />Day Phone 209-323-5350 <br />Night Phone 209-416-7536 <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner ID : <br />d <br />CA 556L9L- <br />?C0 <br />v <br />.�� aec 4`b c <br />Sr��.s , A 9s -C i� <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0016247 <br />NewAccount ID: <br />: <br />Mail Invoices to Account <br />Mail Invoices to: <br />Owner / <br />Facility / <br />Account <br />Account Name David Garcia <br />(Circle One) <br />Account Balance as of 6/12/2015: $1,231.50 <br />(Circle One) <br />Transfer to <br />Active/Inactve <br />Program/Element and Description <br />Record ID <br />Employee ID and Name <br />Status <br />New Owner? <br />Delete <br />1920 - HMBP-Common Materials <br />PR0521188 <br />EE0000006 - HAZA SAEED <br />Active <br />Y N <br />A I D <br />2220 - SM HW GEN <5 TONS/YR <br />PR0513723 <br />EE0000027 - CINDY VO <br />Active <br />Y N <br />A I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0511535 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y N <br />A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F <br />PR0509247 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y N <br />A I D <br />3122 - STORMWATER INSPECTION - AUTO SHOP <br />PRO529446 <br />EE0009488 - JEFFREY WONG <br />Inactiw <br />Y N <br />A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG <br />PR0533008 <br />Inactive <br />Y N <br />A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent <br />of same, acknowledge that all site, and/or project specific, <br />PHS/EHD 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 <br />will be performed in accordance with all applicable Ordinance Codes and/or Standards <br />and Stale and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff. <br />COMMENTS: <br />$25.00 = <br />Date <br />Date / / <br />Amount Paid Date -/-/ <br />_ Amount Paid Date <br />Received by <br />Account out: Date TT ✓S <br />Invoice#: <br />