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Date run 10/10/2018 12:52:111 SAN JOAQUIN CQ6NT&NYIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by d Pagel <br /> Facility Information as of 10/10/2018 <br /> Record Selection Criteria: Facility ID FA0003559 <br /> Make changes/corrections in RED ink. p <br /> INFORMATION CHANGE(date) a <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0002666 New Owner ID <br /> Owner Name LKQ AUTO PARTS OF CENTRAL CA <br /> Owner DBA LKQ ACME TRUCK PARTS <br /> Owner Address 500 W MADISON ST 2800 <br /> CHICAGO, IL 60661 <br /> Home Phone Not Specified <br /> Work/Business Phone 661-832-8733 <br /> Mailing Address 1016 S WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0003559 10181217 <br /> Facility Name LKQ ACME TRUCK PARTS <br /> Location 2546 TURNPIKE RD <br /> STOCKTON, CA 95206 <br /> Phone 209-466-7021 x0 <br /> Mailing Address 1016 S WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of Mike Hofer <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 16526125 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 AR0003137 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name LKQ ACME T CK PA,R 5- (Circle One) <br /> Account Balance as of 10/10/2018: $ 2.00 ��R <br /> ' <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description rd ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0535245 EE0009817-ROBERT LOPEZ Active Y N AI D <br /> 2220-SM HW GEN<5 TONS/YR PR0539985 EE0000026-CESAR RUVALCABA InactivE Y N I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0232196 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0523983 EE0002622-BENJAMIN ESCOTTO InactivE Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0535262 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,PHS/EHD hourly charges associated with this facility <br /> 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 Ordinance Codes and/or Standards and State and/or <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 Ty p Check Number Received y <br /> EHD Staff: Date /-If— Account out: Date <br /> COMMENTS: I' If / eo &V <br /> Invoice#: <br />