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Date run 2/8/2017 10:07:38AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/8/2017 <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 g ID : <br /> Owner Name William Peat A"( �.. C' <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 209-712-4737 <br /> Mailing Address 2100 Sanguinetti Ln <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID I 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 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION .nn n <br /> Contact Name PEAT, WILLIAM mO-210 <br /> Title <br /> Day Phone 209-779-5701 <br /> Night Phone 209-712-4737 D 16 N z <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016845 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name All 4 one autocare (Clrcleonne) <br /> Account Balance as of 2/8/2017: $1,009.40 <br /> (Circle One) <br /> Transfer to AclivellnacNe <br /> PrograMElement and Description Record ID Employee ID and Name Status New OwneO Delete <br /> 1920-HMBP-Common Materials PR0519913 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO514059 EE0000023-PAULINE MANGRAI Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512133 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <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 F PR0507435 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509845 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532851 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,ope at.r or agent of same,acknowledge that all site,andor protect sPecdm,PHSIEHD hourly charges associated with Nis facility <br /> or activity will be billed to the party identified as Ne OWNER on this form. I also certify that 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 T SFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: `L Date / Z / L?— Account out: Date_/ �f /1 7 <br /> COMMENTS: - <br /> Y tfw" 4V �IInvoricee#: <br /> / Ii/ V w fW�to ) <br />