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Date ran 12/7/2017 1:54:55Pry SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 12/7/2017 <br /> Record Selection Criteria: Facility ID FA0009188 <br /> Make changestcorrections 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 OW0007188 Case Number: H01830 New Owner ID <br /> Owner Name TERALT <br /> Owner DBA WESTERN RADIATOR <br /> OwnerAddress 1780 E ROOSEVELT ST <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-466-2733 <br /> Mailing Address 1780 E ROOSEVELT ST <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009188 10182495 <br /> Facility Name WESTERN RADIATOR <br /> Location 1780 E ROOSEVELT ST <br /> STOCKTON, CA 95205 <br /> Phone 209-466-2733 x <br /> Mailing Address 1780 E ROOSEVELT ST <br /> STOCKTON, CA 95205 <br /> Care of AI Tassano <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOB District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 14108301 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 AR0016188 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name WESTERN RADIATOR (Chicle One) <br /> Account Balance as of 12/7/2017: $0.00 <br /> (Circle One) <br /> Transfer to AcINWInactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519446 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513692 EE9999996-THREE VACANT3 Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511476 EE9999996-THREE VACANT3 Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F1 PR0509188 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PRO529450 EE0009488-JEFFREY WONG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO533752 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anc/or project specific,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to Ne party identified as the OWNER on this form. I also certify Chet all operations will be performed in accordance with all applicable Ordinance Codes andror Standards and State and'or <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 <br /> COMMENTS: Invoice#: <br />