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Date ran 12/19/2017 10:22:44/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 12/19/2017 <br /> Record Selection Criteria: Facility ID FA0010163 <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 OW0008163 Case Number: H07000 New Owner ID <br /> Owner Name CORDIANO,ANTHONY <br /> Owner DBA .JAGUAR HEAVEN AUTO DISMANTLERS <br /> OwnerAddress 1433 TILLIE LEWIS DR <br /> STOCKTON, CA 952061130 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-9424524 <br /> Mailing Address 1433 TILLIE LEWIS DR <br /> STOCKTON, CA 95206-1130 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0010163 10183283 <br /> Facility Name JAGUAR HEAVEN AUTO DISMANTLERS <br /> Location 1433 TILLIE LEWIS DR <br /> STOCKTON, CA 95206-1120 <br /> Phone 209-9424524 x <br /> Mailing Address 1433 TILLIE LEWIS DR <br /> STOCKTON, CA 95206-1130 <br /> Care of Anthony Cordiano <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 16335002 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017163 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name JAGUAR HEAVEN AUTO DISMANTLERS (Circle One) <br /> Account Balance as of 12/19/2017: $0.00 <br /> (Circle One) <br /> Transfer to ActiveAnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO520112 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514208 EE0000026-CESAR RUVALCABA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512451 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO510163 EE000o000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523521 EE0009000-HARPRIT MATTU Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO534507 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOVVLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project speck,PHSfEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and Stale andor <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 Check Number Received by <br /> EHD Staff: Date_/ / Account out: Date_/ / <br /> COMMENTS: <br /> Invoice#: <br />