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Date run 9/25/2014 3:54:06PR SAN JO IN COUNTY ENVIRONMENTAL HEALODEPARTMENT Report 41121 Pagel Run by Facility Information as of 9/25/2014 Record Selection Criteria: Facility ID FA0010087 OWNER FILE INFORMATION Number of facilities for this owner Owner ID OW0008087 Owner Name CATCHOT, SCOTT Owner DBA U STRIP IT INC Owner Address 8258 S PLUMERIA AVE Record ID FAIR OAKS, CA 95628 Home Phone 916-417-9040 Work/Business Phone 209-948-8345 Mailing Address 8258 PLUMERIA AVE Care of FAIR OAKS, CA 95628 care of CATCHOT, SCOTT FACILITY FILE INFORMATION Facility ID / CERS ID FA0010087 10183197 Facility Name U STRIP IT INC Location 3175 S HWY 99 W FRONTAGE RD Record ID STOCKTON, CA 95215 Phone 209-948-8345 Mailing Address 3175 S HWY 99 W FRONTAGE RD EE0008709 - JAMIE DE LA ROSA STOCKTON, CA 95215 Care of CATCHOT, SCOTT Location Code 99 - UNINCORPORATED P Bos District 001 - VILLAPUDUA APN 17910012 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0017087 Mail Invoices to Facility Account Name U STRIP IT INC Account Balance as of 9/25/2014: $2,275.00 Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN I Fed Tax ID New Owner ID :. Alt Phone Fax Eli New Account ID: : Mail Invoices to: Owner / Facility / Account (Circle One) (Circle One) Activellnaclve Delete (I ) D � D I D I D I D 1 D 1 D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, Ne undersigned owner, operator or agent of same, acknowledge that all site, andor 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 andia Federal Laws. APPLICANTS SIGNATURE: Program Records to be TRANSFERED: Water System to be TRANSFERED: Date • $25.00 = Amount Paid Date_ Amount Paid Date Payment Tya —�--Check Number Receivedtby REHS �'�Oe11-.71kl-L-- Date /2� /1 Account ou1t1 Kl J �Dattee COMMENTS:61I .��iVl�,kSS holM�-�""' 1�n ' V�Vr!/e I'Vr t lAt TTTrr, tybV V`ri4N "(tlJ Transferto Program0emenl and Description Record ID Employee ID and Name Status New Omen 1921 HMBP-Regular-Primary Location PR0520065 EE0008709 - JAMIE DE LA ROSA Active Y N A - 2217 RECYCLER PRO521490 EE0009488 - JEFFREY WONG Inactive Y N A -APPLIANCE 2220 -SM HW GEN <5 TONS/YR PR0514163 EE0001421 -STACY RIVERA Active Y N A 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512375 EE0000000 - HAZ MAT SJC IDES Inactive Y N A 2399 UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510087 EE0000000 - HAZ MAT SJC OES Inactive Y N A - 4740 - WASTE TIRE SITE - EXEMPT PR0536147 EE0002622 - BENJAMIN ESCOTTO Inactive Y N A ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0531943 Inactive Y N A (Circle One) Activellnaclve Delete (I ) D � D I D I D I D 1 D 1 D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, Ne undersigned owner, operator or agent of same, acknowledge that all site, andor 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 andia Federal Laws. APPLICANTS SIGNATURE: Program Records to be TRANSFERED: Water System to be TRANSFERED: Date • $25.00 = Amount Paid Date_ Amount Paid Date Payment Tya —�--Check Number Receivedtby REHS �'�Oe11-.71kl-L-- Date /2� /1 Account ou1t1 Kl J �Dattee COMMENTS:61I .��iVl�,kSS holM�-�""' 1�n ' V�Vr!/e I'Vr t lAt TTTrr, tybV V`ri4N "(tlJ