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Data run 3/4/2013 11:59:42AM SAN J COUNTY ENVIRONMENTAL HEAW DEPARTMENT Repo *5021 <br /> Run by Pagel <br /> Facility Information as of 3/4/2013 <br /> Record Selection Criteria: Facility ID FA0010832 <br /> Make changes/corrections In RED ink <br /> INFO . 3 /� <br /> - <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008832 Case Number: H08836 New Owner ID <br /> Owner Name CASTO, JAMES & KIMBERLY <br /> Owner DBA TERRY'S CHEROKEE RV SVC <br /> Owner Address 2460 N WILSON WAY <br /> STOCKTON, CA 952053130 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-465-1425 <br /> Mailing Address 2460 N WILSON WAY <br /> STOCKTON, CA 952053130 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010832 <br /> Facility Name TERRYS CHEROKEE RV SVC <br /> Location 2460 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Phone 209-465-1425 xO <br /> Mailing Address 2460 N WILSON WAY <br /> STOCKTON, CA 952053130 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOB District 002 - RUHSTALLER, LARRY Fax <br /> APN 11706038 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title ����,e.-G" -•r <br /> Day Phone <br /> Night Phone r ,, <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017832 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name CASTO, JAMES & KIMBERLY (Circle One) <br /> Account Balanc8sTf 3/ /r2Q1 $548.00 <br /> (Circle One) <br /> ✓' 1 Transfer to Activellnadve <br /> Program/Element an60 / Z© Record ID Employee ID and Name Status New Owner? Delete <br /> H P-Regular-Primary Location PRO520513 EE0006044-LOWELL ALLEN Active Y N A I D <br /> -SM HW GEN<5 TONSNR PRO529463 EE0009488-JEFFREY WONG Active Y N A I D <br /> 24-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0513120 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PRO510832 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PR0529464 EE0009488-JEFFREY WONG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PRO534738 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Ne undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form Ialso certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and Stale andor <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 Type Check Number Re iv b <br /> REFS: ��"� F--L Date�;�/� Account out: Date <br /> COMMENT S: RA <br />