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Daterun , 8/242015 2:44:11PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 8/25/2015 <br />Record Selection Criteria: Facility ID FA0015139 <br />Make changestcorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0012116 <br />Owner Name <br />PHILPOTT, DAVID J <br />Owner DBA <br />PHILPOTT'S GARAGE <br />Owner Address <br />1411 CHESTER DR <br />Mailing Address <br />TRACY, CA 95376 <br />Home Phone <br />209-835-3360 <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />1411 CHESTER DR <br />BOS District <br />TRACY, CA 95376 <br />Care of <br />25015003 <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0015139 10184871 <br />Facility Name <br />PHILPOTTS GARAGE <br />Location <br />7880 W ELEVENTH ST <br />TRACY, CA 95304 <br />Phone <br />209-835-2262 <br />Mailing Address <br />7880 W 11TH ST <br />TRACY, CA 95304 <br />Care of <br />DAVID J PHILPOTT <br />Location Code <br />BOS District <br />APN <br />25015003 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name DAVID J PHILPOTT <br />Title <br />Day Phone 209-835-2262 <br />Night Phone 209-835-3360 <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />1 SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0025985 <br />Mail Invoices to Facility Mail Invoices to: <br />Account Name PHILPOTTS GARAGE <br />Account Balance as of 8/25/2015: $0.00 <br />New Account I D: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />2220 - SM HW GEN <5 TONS/YR PR0522212 EE0002646 - THUY TRAN Active Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0532533 Inactive Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD 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 be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: <br />COMMENTS: <br />* $25.00 = <br />Date <br />Date <br />Amount Paid Date <br />_ Amount Paid Date <br />Received by <br />Account out: Date <br />Invoice #: <br />