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Date run 9/8/2016 1:02:21PM SAN JOAQUINCOUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repa,l#5011 <br /> Run by Pagel <br /> Facility Information as of 9/8/2016 <br /> Record Selection Criteria: Facility ID FA0009845 <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 r <br /> Owner ID OW0007845 Case Number: H05621 New Owner ID <br /> Owner Name SALGADO, GUILLERMO <br /> Owner DBA ORLANDO'S AUTOMOTIVE CENTER <br /> Owner Address 2015 NAPA RIVER DR 1 <br /> STOCKTON, CA 95205 Z V <br /> Home Phone 209_271.2288Tic- <br /> Work/Business Phone 209-481-5562 <br /> Mailing Address 2015 NAPA RIVER DR c <br /> STOCKTON, CA 95205 d <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0009845 10182951 <br /> Facility Name ORLANDO'S AUTOMOTIVE CENTER _ 1/ Ef 00r A o <br /> Location 2100 SANGUINETTI LN L7yU �r. 2r -.t ts.�N <br /> STOCKTON, CA 95205 c'T.�k l` its (?< 7 <br /> Phone 209-481-5562 log <br /> Mailing Address 2015 NAPA RIVER DR 14 <br /> STOCKTON, CA 95205 ocl. <br /> Care of SALGADO, GUILLERMO <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 11908015 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title r' <br /> Day Phone V 14 <br /> Night Phone � •`� <br /> ACCOUNTS RECEIVABLE FILE INFORMATION 0 <br /> Account ID AR0016845 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ORLANDO' UTOMOTIVECENTER (Circle One) <br /> Account Balance as of 9/8/2016: $1, 1.00 <br /> (Circle One) <br /> Transfer to Activei'actee <br /> ProgrardElemeat and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519913 EE0000006-HAZA SAEED Inactive Y N A 1 D <br /> 2220-SM HW GEN<5 TONSNR PR0514059 EE0000015-TIMOTHY ENGLE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512133 EE0000000-HAZ MAT SJC OES 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 PR0509845 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532851 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge Nat all site,ander project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the partyIdentified as the \ eER an this form. I also certify Nat all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ander <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 �h`eck Number Received by <br /> EHD Staff: �,j�Q� Date / /1� Account out: Date <br /> COMMENTS: Invoice#: <br />