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Date run 12/31/2015 9:49:22A SAN JOCOUNTY ENVIRONMENTAL HEAL EPARTMENT Report#5021 <br /> Run by �" Pagel <br /> Facility Information as of 12/31/2015 <br /> Record Selection Colons: Facility ID FA0009280 <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 OW0007280 Case Number: H02762 New Owner ID <br /> Owner Name LENDER, SCOTT <br /> Owner DBA AUTOFIX OF STOCKTON <br /> OwnerAddress 7374 MURRAY DR <br /> STOCKTON, CA 95210 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-474-1881 <br /> Mailing Address 7374 MURRAY DR <br /> STOCKTON, CA 95210 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0009280 10182563 <br /> Facility Name AUTOFIX OF STOCKTON <br /> Location 7374 MURRAY DR <br /> STOCKTON, CA 95210 <br /> Phone 209474-1881 x <br /> Mailing Address 7374 MURRAY DR <br /> STOCKTON, CA 95210 <br /> Care of Scott Lender <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 09402028 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 AR0016280 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AUTOFIX OF STOCKTON (Circle One) <br /> Account Balance as of 12/31/2015: $0.00 <br /> (Circle One) <br /> Transfer to ActiveflnacNe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0519514 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513744 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511568 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO509280 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532144 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersignetl owner,operator or agent of same,acknowledge that all site,ancifor project specific,Plisi 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 will be performed in accordance with all applicable Ordinance Codes andfor Standards and State andfor <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 /> EHD Staff: Date / / Account out: Date / I <br /> COMMENTS: <br /> Invoice#: <br />