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Date' un �/w5/2012 9:17: SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Rev°"xsozl <br /> Run oy�-- .___.__________________—__Ssmi._ <br /> Facility Information a <br /> Record Selection Criteria: FacilitylD FA0009097. - 'TONNIE-MALLORIR- -( <br /> Ma I <br /> �v� 1 <br /> OWNER FILE INFORMATION SS <br /> Owner 1D OW0007097 Case Number: H01136 Ne 1 n <br /> Owner Name CRONIN, BILU CHRISTENSEN, E <br /> Owner DBA BIG O TIRES#31 <br /> Owner Address 810 E YOSEMITE AVE G <br /> MANTECA, CA 95336 Oil 'U�" 1 e <br /> Home Phone 209-599-5104 _ <br /> Work/Business Phone 209-239-9591 `p <br /> Mailing Address 810 E YOSEMITE AVE �T <br /> MANTECA, CA 95336 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009097 <br /> Facility Name BIG O TIRES#31 <br /> Location 810 E YOSEMITE AVE V - V�7iCiU�/ UV� <br /> MANTECA, CA 95336 <br /> Phone 209-239-9591 <br /> Mailing Address 810 E YOSEMITE AVE <br /> MANTECA, CA 95336 <br /> CarN, BILL <br /> Location Codeode 04 04-- MANTECA All •• ���� <br /> BOS District 005-ORNELLAS, LEROY Fa <br /> APN 22118016 E <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION VI UU <br /> Contact Name 111 / <br /> Title (� - <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION rn i <br /> Account ID AR0016097 �rlQ(/�„�yj2lj <br /> Mail invoices to Facility L� <br /> Account Name BIG O TIRES#31 <br /> Account Balance as of 6/5/2012: $568.50 <br /> Progrann Element and Description Record ID Employee ID and Name Status New Owner? e e e <br /> 1920-HMBP-Common Materials PRO520347 EE0002474-MICHAEL PARLSSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513637 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOPPR0511385 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0509097 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0522392 EE0002620-ALFONSO ARAMBULA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PRO533643 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will he billed to the party identified as the OWNER on this form 1 also certify that all operations will be performed in accardaicewith all applicable Ordinance Codes and+or Standards and Stale ansor <br /> Federal Lam. <br /> APPLICANTS SIGNATURE: Date / ! <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I_I <br /> Nater System to be TRANSFERED: Amount Paid Date <br /> ayment Type Check Number Received by ' <br /> :HS: Date / /_ Account out: Date <br /> MMENTS: <br />