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Date run 4/29/2015 8:18:37AN SAN JC 'UIN COUNTY ENVIRONMENTAL HEA -I DEPARTMENT Repo#5021 'Run by � Pagel Facility Information as of 4/29/2015 Record Selection Criteria: Facility ID FA0009247 ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0016247 Mail Invoices to Facility Account Name B&H TRANSMISSION AND AUTO CARE Account Balance as of 4/29/2015: $1,018.50 Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN /Fed Tax ID New Owner ID .39-73 •'v- LL EML 5-7DcZ--7a 0 &4q 4S�P-ro %69 5 �- Alt Phone Fax EMail: Mail Invoices to New Account ID: : Owner / Facility / Account (Circle One) (Circle One) Transfer to Active/Inactve Program/Element and Description Record ID A 111copy New Owner? OWNER FILE INFORMATION Number of facilities or is owner : 1 Owner ID OW0007247 Case Number: H02373 Owner Name Ruben Lopez and David Garcia Owner DBA B&H TRANSMISSION AUTO CARE Owner Address 2220 - SM HW GEN <5 TONS/YR PR0513723 STOCKTON, CA 952G3 -- Home Phone 209-298-2959 Work/Business Phone 209-298-2959 Mailing Address PR0511535 EE0000000 - HAZ MAT SJC OES STOCKTON, CA 9&263— Care of LOPEZ, RUBEN & GARCIA, DAVID FACILITY FILE INFORMATION 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F Facility ID / CERS ID FA0009247 10182543 Facility Name B&H TRANSMISSION AND AUTO CARE Location 3422 E MINER AVE 3122 - STORMWATER INSPECTION -AUTO SHOP STOCKTON, CA 95205 Phone 209-323-5350 x Mailing Addressd�r�,� A I D STOCKTON, CA H R-3 Care of LOPEZ, RUBEN & GARCIA, DAVID Location Code Y N BOS District I D APN 14339009 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name LOPEZ, RUBEN & GARCIA, DAVID Title OWNER Day Phone 209-323-5350 Night Phone 209-298-2959 ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0016247 Mail Invoices to Facility Account Name B&H TRANSMISSION AND AUTO CARE Account Balance as of 4/29/2015: $1,018.50 Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN /Fed Tax ID New Owner ID .39-73 •'v- LL EML 5-7DcZ--7a 0 &4q 4S�P-ro %69 5 �- Alt Phone Fax EMail: Mail Invoices to New Account ID: : Owner / Facility / Account (Circle One) (Circle One) Transfer to Active/Inactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1920 - HMBP-Common Materials PR0521188 EE0000006 - HAZA SAEED Active Y N A I D 2220 - SM HW GEN <5 TONS/YR PR0513723 EE0000027 - CINDY VO Active Y N A I D 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511535 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509247 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D 3122 - STORMWATER INSPECTION -AUTO SHOP PR0529446 EE0009488 - JEFFREY WONG Inactive Y N A I D ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0533008 Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly charges associated with this facility 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 and/or Standards and State and/or Federal Laws, APPLICANT'S SIGNATURE: _rr r– Ali k-�� ),--✓o Date/ , u / IS— Program Records to be TRANSFERED: Water System to be TRANSFERED: Payment Type Check Number REHS: * $25.00 = Amount Paid Date Amount Paid Date Received by �^ Date / / Account out: Date// lJ COMMENTS: VCIA�nt) Llr"TV CL- 0 /,vim �� o S - � - /-/b7- 5 ;� 607n 4 St 7�� AHA�,yb)L (s