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Date run 11/13/2018 11:35:54P SAN JOAQUIN COUNTY ENA✓IRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/13/2018 <br /> Record Selection Criteria: Facility ID FA0003559 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) �� l <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 /> OwnerAddress 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 /> C/-627-5126 <br /> FACILITY FILE INFOR <br /> Facility ID/CE000355 10181217 <br /> Facility ride Tr k Sales <br /> Loc546 RNPIKE RD <br /> T KTON, CA 95206 f� ) <br /> P -627-5126 x0Mailing Ad16 S WILSON WAYTOCKTON, CA 95205Cike HoferLocation -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, MIGUEL 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 Pride Truck Sales (Circle One) <br /> Account Balance as of 11/13/2018: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0535245 EE0009817-ROBERT LOPEZ Inactive Y N A U D <br /> 2220-SM HW GEN<5 TONS/YR PR0539985 EE0000026-CESAR RUVALCABA Inactive Y N A 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 SURCHARGI 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 a TRANSFERED: '$25.00= Amount Paid Date <br /> Water System , be RANSFERED: Amount Paid Date <br /> Payment Type( Check Number Received by <br /> EHD Staff: A Date / _/�� Account out: Date <br /> COMMENTS: <br /> Invoice#: <br />