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Date run 5l29l2015 8:49:OOAA SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT <br /> Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/29/2015 <br /> Record Selection criteria: Facility ID FA0018637 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN 1 Fed Tax ID <br /> Owner ID OW0015314 New Owner ID <br /> Owner Name NORCAL MUFFLER &TRUCK INC <br /> Owner DBA NORCAL MUFFLER &TRUCK INC <br /> Owner Address 6406 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Home Phone Not Specified <br /> Work./Business Phone 209_952-3022 <br /> Mailing Address 6406 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0018637 10186913 <br /> Facility Name NORCAL MUFFLER &TRUCK INC <br /> Location 6406 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone 209_952-3022 x0 <br /> Mailing Address 6406 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 002 - MILLER, KATHERINE Fax <br /> APN 08126027 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 AR0033002 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility 1 Account <br /> Account Name NORCAL MUFFLER &TRUCK INC (Circle One) <br /> Account Balance as of 512912015: $0.00 <br /> (Circle One) <br /> Transfer to Actiuelinactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0527506 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0538571 EE0000005-FATINAH ZAREEF Inactive: Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534714 Inactiv( Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT- I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSlEHD hourly charges associated with this facility <br /> or activity will be clued to the party identified as Me 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 and/or <br /> 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 /> Payment Type Check Number Received by <br /> EHD Staff: Date ! ! Account out: Date 1 1 <br /> COMMENTS. Invoice#: <br />