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Data tun 3/25/2015 8:50:28AR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#W21 <br /> Run by <br /> Facility Information as of 3/25/2015 Page' <br /> Record Selection Criteria: Fadlity ID FA0017944 I <br /> DJVWA <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/Fed Tax ID : <br /> Owner ID OW0014740 New Owner ID <br /> Owner Name <br /> Owner DBA HONEST AUTOMOTIVE <br /> Owner Address 923 MOFFAT BLVD <br /> MANTECA, CA 95336 <br /> Home Phone Not Specified <br /> Work/Business Phone-a99-67S.901-3- 20 3q _G 62�\ <br /> Mailing Address 923 MOFFAT BLVD <br /> MANTECA, CA 95336 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017944 10186715 <br /> Facility Name Element 6 Motor Werks Inc <br /> Location 923 MOFFAT BLVD <br /> MANTECA, CA 95366 <br /> Phone 209-239-0639 x <br /> Mailing Address 923 MOFFAT BLVD <br /> MANTECA, CA 95336 <br /> Care of Element 6 Motor Werks Inc <br /> Location Code 04- MANTECA Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 22115002 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone LQ"LS� 'l-&A-,l <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0031477 .( New Account ID: <br /> Mail Invoices to Owner r Mail Invoices to: Owner / Facility / Account <br /> Account Name dOH -NL\emC1\'c (Circle One) <br /> Account Balance as of 3/25/ 15: $363.00 <br /> (Circle One) <br /> Transfer W Aovefna <br /> Program'Element and Description Record ID Employee ID and Name Status New OwrreY] Delete <br /> 1920-HMBP-Common Materials PRO526503 EEDOOGO06-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0538587 EE0009001 -ELENA MANZO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532164 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT r I,me undersigned owner,operator r agent of some,acknowledge that all site,ai project speafc,PHSrEHD hourly charges associated with this facility or: <br /> be billed to the party identified as the OWNER on this form. I also comfy that all operations will be performed in accordance with all applicable Ordinance Codes angor Standards and State anclor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: Amount Paid Date <br /> PaymentType Check Number Received y <br /> REHS: W: Wil— Date .3 N, Account out: Date <br /> COMMENTS: <br /> F-\ev-�er� � 'l`L\p-!Q� V�-`C�S \rC \r\ac� be.e,r `ate � i�t�,•S �pC.a��nj� <br /> S •V\CSL, \o-\- a Q \�\ - Q.\\ Fo^C 3 Cha�.. WnS <br />