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Date run 8/18/2015 8:52:22AN SAN JUIN COUNTY ENVIRONMENTAL HE i DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/18/2015 <br /> Record Selection Criteria: Facility ID FA0009949 <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: 1 SSN I Fed Tax ID : <br /> Owner ID OW0007949 Case Number: H05980 New Owner ID : <br /> Owner Name GAMEZ,ALDO <br /> Owner DBA PRO-TOUCH AUTO REPAIR <br /> OwnerAddress 728 BISHOP ST <br /> MANTECA, CA 95337 <br /> Home Phone 209-824-8182 <br /> Work/Business Phone 209-471-9464 <br /> Mailing Address 728 BISHOP ST <br /> MANTECA, CA 95337 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS I❑ FA0009949 10183055 <br /> Facility Name PRO-TOUCH AUTO REPAIR <br /> Location 255 MOFFAT BLVD <br /> MANTECA, CA 95336-5742 <br /> Phone 209-239-9250 x <br /> Mailing Address 255 MOFFAT BLVD <br /> MANTECA, CA 95336-5742 <br /> Care of ALDO JOEL& DONNA GAMEZ <br /> Location Code 04- MANTECA Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 22106021 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account I❑ AR0016949 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility 1 Account <br /> Account Name PRO-TOUCH AUTO REPAIR (Circle One) <br /> Account Balance as of 8/18/2015! $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Descriptlon Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0519981 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN t5 TONSIYR PR0514107 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512237 EE0000000-HAZ MAT SJC OES Inactive Y N A I ❑ <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO509949 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC ELECTRONIC REPORTING STATE SURCHARGI PRO533887 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identil as the OWNER on this form_ I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andlor Standards and State andror <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date I <br /> Water System to be TRANSFERED: Amount Paid Date ! I <br /> Payment Type Check Number Received by <br /> EHD Staff: Date 1 I Account out: Date i <br /> COMMENTS: <br /> Invoice#: <br />