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RWmn 3i4/2014 10:35.05AM SAN JO.�JIN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Region#5021 <br /> by <br /> Facility Information as of 3/4/2014 Pal <br /> Record Selection Criteria: Facility ID FA0009211 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNI Fed Tax ID <br /> Owner ID OW0007211 Case Number: H02105 New Owner ID <br /> Owner Name DEBCO AUTO WRECKING INC <br /> Owner DBA DEBCO AUTO WRECKING INC <br /> Owner Address 2345 NAVY DR <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-466-0164 <br /> Mailing Address PO BOX 6095 <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0009211 10,182,517 <br /> Facility Name DEBCO AUTO WRECKING INC <br /> Location 2345 NAVY DR <br /> STOCKTON, CA 95206 <br /> Phone 209-466-0164 <br /> Mailing Address PO BOX 6095 <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16332003 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 AR0016211 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to. Owner / Facility / Account <br /> Account Name DEBCO AUTO WRECKING INC (Circle One) <br /> Account Balance as of 3/4/2014: $578.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New OwneR ,,��Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519658 EE0009817-ROBERT LOPEZ Active Y N A y I D <br /> 2220-SM HW GEN<5 TONS/YR PRO513701 EE0001421 -STACY RIVERA Active Y N A I J D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511499 EEOOO0000-HAZ MAT SJC CES Inactive Y N A D <br /> 2226-CaIARP PROGRAM PRO514539 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509211 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523989 EE0002620-ALFONSO ARAMBULA Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531762 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor protect specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party ideniRed as the OWNER on this form. I also certify that all operations will be Performed in accordance with all applicable Ordinance Codes andior Standards and State andfor <br /> Federal Laws. <br /> �'f e is 66-1`7.7 o &-rGc <br /> APPLICANT'S SIGNATURE: Date / I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date I I <br /> Payment Type _ Check NumberRece <br /> REHS. Date / / Account out: Date <br /> COMMENTS: <br />