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Date run 812812015 9:03:26AN SAN JOAON COUNTY ENVIRONMENTAL HEAL#EEARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/28/2015 <br /> Record Selection Criteria: Facility ID FA0020538 <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 OW0016880 New Owner ID <br /> Owner Name ROY RIVERA <br /> Owner DBA K&J AUTO REPAIR <br /> Owner Address 519 N SIERRA NEVADA ST <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-607-1280 <br /> Mailing Address 519 N SIERRA NEVADA ST <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0020538 10187627 <br /> Facility Name K&J AUTO REPAIR <br /> Location 519 N SIERRA NEVADA ST - <br /> STOCKTON, CA 95205 <br /> Phone 209-607-1280 x0 <br /> Mailing Address 519 N SIERRA NEVADA ST <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code Alt Phone <br /> SOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 15109409 Ell <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone - <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0036742 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility 1 Account <br /> Account Name ROY RIVERA (Circle pre) <br /> Account Balance as of 812812015: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0535614 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO538606 EE0000027-CINDY VO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0535970 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned owner.operator or agent of same,acknowledge that all site,and7or project specific.PHWHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER onthis form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State arl <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 f <br /> Water System to be TRANSFERED: Amount Paid Date f 1 <br /> Payment Type Check Number Received by <br /> END Staff: Date 1 1 Account out: Date 1 1 <br /> COMMENTS: Invoice#: <br />