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Date mn 11/29/2017 2:02:OOP SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by DONNA Pagel <br /> Facility Information as of 11!29/2017 <br /> Record Selection Criteria: Facility ID FA0009845 <br /> Make changes/corrections 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 OW0007845 Case Number: H05621 New Owner ID <br /> Owner Name Mario Padilla <br /> Owner DBA All 4 one Auto Care <br /> Owner-Address 2100 SANGUINETTI LN <br /> STOCKTON, CA 95205 <br /> Home Phone 209-779-5701 <br /> Work/Business Phone 209-981-6426 <br /> Mailing Address 2100 Sanguinetti Ln. <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0009845 10182951 <br /> Facility Name ALL 4 ONE AUTO CARE <br /> Location 2100 SANGUINETTI LN <br /> STOCKTON, CA 95205 <br /> Phone 209-779-5701 x <br /> Mailing Address 2100 SANGUINETTI LN <br /> STOCKTON, CA 95205 <br /> Care of All 4 one autocare <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 11908015 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name All 4 one autocare <br /> Title <br /> Day Phone 209-779-5701 <br /> Night Phone 209-981-6426—Voice Mo;Aox <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016845 NewAccouri <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ALL 4 ONE AUTO CARE (Circle One) <br /> Account Balance as of 11/29/2017: $1, ��rµ� c/ <br /> ��� OCC- (circle on <br /> —� Transfer to ActweM c e <br /> PromemlElement and Description Record ID Employee ID and Name Status New Owner? DeltA <br /> 1920-HMBP-Common Materials PRO519913 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO514059 EE9999996-THREE VACANT3 Active Y N <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512133 EE9999996-THREE VACANT3 Inactive Y N A I - <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0231725 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO507435 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509846 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO532851 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned!owner,operator or agent of same,acknowledge that all site,andvor protect specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also cedRy that all operations will be performed in accordance with all applicable Ordinance Codes andvor Standards and State andlor <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 heck Number ei <br /> EHD Staff: Date ut: Date 11-2-1 lD /t7 <br /> COMMENTS: <br /> c t>CD / ' e0.St' ativtS2 Invoice#: 297 g`f <br />