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Date,Sm 2/21/2007 9:07:45AK SAN JOAQUIN COUNTY ENVIRONMENTAL HEA 11-4 DEPARTMENT Report#5021 <br /> Run by 5290 Pagel <br /> Facility Information as of 2/21/2 <br /> Record Selection Criers: Facility ID FA0009798 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0007798 Case Number: H05448 New Owner ID <br /> Owner Name HAYN, BRIAN <br /> Owner DBA TUNE UP SHOP&SVC CTR INC (ST <br /> Owner Address 810 E HARNEY LN <br /> LODI, CA 952429534 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-369-5464 <br /> Mailing Address 810 E HARNEY LN <br /> LODI, CA 952429534 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009798 <br /> Facility Name TUNE UP SHOP &SVC CTR INC <br /> Location 7711 THORNTON RD <br /> STOC A 95207 <br /> Phone 209-951-78441-7844 <br /> Mailing Address 810 E HARNEY LN <br /> LODI, CA 952429534 <br /> Care of <br /> Location Code APN 077-490-18 <br /> BOS District SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016798 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name TUNE UP SHOP&SVC CTR INC (Circle One) <br /> Account Balance as of 2/21/2007: $230.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514038 EE0008317-RAYMOND VON FLUE Active Y N A �p D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512086 EE0000000-HAZ MAT SJC IDES Inactive Y N A D <br /> 2244-PACT TRANSFER RECORD-OES PRO519875 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPR0509798 EE0o00000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PFIS/EFID hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes andlor Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: _*$372.00= Amount Paid Date / / <br /> Payment Type Check Number Received LIS <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />