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Date run 12/21/2017 10:16:23/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 Run by Pagel Facility Information as of 12/21/2017 Record Selection Criteria: Facility ID FA0003844 Make changes/corrections in RED ink. INFORMATION CHANGE(date) OWNERSHIP CHANGE(date) OWNER FILE INFORMATION Number of facilities for this owner: 40 SSN/Fed Tax ID : Owner ID OW0000353 New Owner ID Owner Name MANTECA, CITY OF Owner DBA OwnerAddress 1001 W CENTER ST MANTECA, CA 95337 Home Phone 209-239-8455 Work/Business Phone 209-456-8710 Mailing Address 1001 W CENTER ST MANTECA, CA 95337 Care of CITY OF MANTECA FACILITY FILE INFORMATION Site Mitigation Facility Facility ID/CERS ID FA0003844 10181475 Facility Name CITY OF MANTECA-VEHICLE MAINTENAN Location 205 E WETMORE ST MANTECA, CA 95337 Phone 209-239-8455 Mailing Address 1001 W CENTER ST MANTECA, CA 95337 care of CITY OF MANTECA-SOLID WASTE Location Code 04- MANTECA Alt Phone BOS District 005 - ELLIOTT, BOB Fax APN 22104008 EMail: EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0003432 New Account ID: Maillnvoicesto Facility Mail Invoices to: Owner / Facility / Account Account Name CITY OF MANTECA-VEHICLE MAI NTENAN (Circle One) Account Balance as of 12/21/2017: $0.00 (Circe One) Transfer to Activellnactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1925-HMBP-Multisite Secondary Location PRO519626 EE0000010-PETER LOMBARDI Inactive Y N A I D 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511717 EE9999997-TWO VACANT2 Inactive Y N A I D 2227-GEN 13<25 TONS PERMIT PR0517873 EE9999997-TWO VACANT2 Inactive Y N A I D 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0231450 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0507497 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509429 EE0000000-HAZ MAT SJC DES Inactive Y N A I D ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0533084 Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project speck,PHSIEHD hourly charges associated with this facility 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 ander Standards and State andlor Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: "$25.00= Amount Paid Date / / Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received by EHD Staff: Date / / Account out: Date / / COMMENTS: Invoice#: