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AgIL <br /> Date run 9/5/2014 4:31:12PM SAN JO IN COUNTY ENVIRONMENTAL HEALM DEPARTMENT Report#5021 <br /> Run by _ Pagel <br /> Facility Information as of 9/5/2014 <br /> Record Selection Criteria: Facility ID FA0010820 <br /> Make changeslcorrections 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 OW0008820 Case Number: H08815 New Owner ID : <br /> Owner Name PARKS, BRAD& PHIL <br /> Owner DBA BILL PARKS AUTO REPAIR INC <br /> Owner Address 6522 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-477-4115 <br /> Mailing Address 6522 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010820 10183843 <br /> Facility Name BILL PARKS AUTO REPAIR INC <br /> Location 6522 PACIFIC AVE <br /> STOCKTON, CA 952073718 <br /> Phone 209-477-4115 <br /> Mailing Address 6522 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002- RUHSTALLER, LARRY Fax <br /> APN 08126039 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 AR0017820 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name BILL PARKS AUTO REPAIR INC (Circle One) <br /> Account Balance as of 9/5/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inache <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner/ Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520509 EE0000006-HAZA SAEED Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513108 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PR0514869 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PRO514427 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510820 EEo000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523800 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531447 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Me undersigned owner,operator or agent of same,acimoMedge that all site,andor project specific,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also cedify,Nat all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ands <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 /> REHS: Date_/_/_ Account out: Date <br /> COMMENTS:. <br />