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Date run 5/18/2015 4:49:12Ph SAN Ji N COUNTY ENVIRONMENTAL NEALT 1EPARTMENT Reporl#5021 <br /> Run by Pagel <br /> Facility Information as of 5118/2015` <br /> .Record Selection Criteria. Facility ID FA001 5751 <br /> Make changes/corrections in FEED 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 IID OW0012682 New Owner ID <br /> Owner Name JAMES HOLLAND <br /> Owner DBA JIM HOLLAND ALIGNMENT & BRAKE <br /> Owner Address 2335 E WATERLOO RD <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-941-6004 <br /> Mailing Address 2335 E WATERLOO RD <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0015751 10185017 <br /> Facility Name JIM HOLLAND ALIGNMENT & BRAKE INC <br /> Location 2335 E WATERLOO RD <br /> STOCKTON, CA 95205 <br /> Phone 209-941-6004 x <br /> Mailing Address 2335 E WATERLOO RD <br /> STOCKTON, CA 95205 <br /> Care of Matthew Marchini <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 11911009 EMall: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0027283 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility 1 Account <br /> Account Name JIM HOLLAND ALIGNMENT& BRAKE INC (Circle One) <br /> Account Balance as of 511812015: $0.00 <br /> (Circle One) <br /> Tran star to Activellnactve <br /> Program/Eleirent and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMSP-Reqular-Primary Location PRO523322 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0529457 EE0000027-UNDY VO Active Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PR0529458 EE0009488-JEFFREY WONG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531262 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSrEHO hourly charges associated with this facility <br /> or activity wil6 be billed to the party identified as the OWNER on this farm, I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andror Standards and State ani <br /> Federal Laws <br /> APPLICANT'S SIGNATURE: Date / 1 <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date I 1 <br /> Water System to be TRANSFERED: Amount Paid Date f 1 <br /> Payment Type Check Number Received by <br /> EHD Staff: Date ! I Account out: Date I 1 <br /> COMMENTS: <br /> Involve#: <br />