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Date run 11/17/2014 4:24:16P ` SAN JOIN COUNTY ENVIRONMENTAL HEAVDEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/17/2014 <br /> Record Selection Chains: Facility ID FA0010160 <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 OW0008160 Case Number: H06968 New Owner ID <br /> Owner Name PAZ, DENNIS <br /> Owner DBA PAZ AUTO &TRUCK REPAIR <br /> Owner Address 2382 WATERLOO RD <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-465-0652 <br /> Mailing Address PO BOX 8873 <br /> STOCKTON, CA 95208 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FAD010160 10183277 <br /> Facility Name PAZ AUTO&TRUCK REPAIR <br /> Location 2382 E WATERLOO RD <br /> STOCKTON, CA 95205 <br /> Phone 209-465-0652 x <br /> Mailing Address PO BOX 8873 <br /> STOCKTON, CA 95208 <br /> care of dennis paz <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 14118101 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 AR0017160 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name PAZ AUTO &TRUCK REPAIR (Circle one) <br /> Account Balance as of 11/17/2014: $0.00 <br /> (Circa One) <br /> Transfer to ActwOnaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0520109 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514206 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512448 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510160 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PR0523024 EE0009488-JEFFREY WONG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533446 Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specific,PHSEHD 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 in,performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws. <br /> APPLICANTS 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 /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />