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Fab 02,11 11:37a Darlene J. Gibbons 209-870-4427 p.2 <br /> 32/02/2011 NED 11:21 FAX 20946F 13 SSC Sao (M002/002 <br /> Lar rad <br /> oeM ran 2/2201111:04:43AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT rte�n�azt <br /> Rushy Plget <br /> Facility Information as of 2/212011 <br /> Remind Selection Cntena. Faelllyll) FAGO16202 <br /> /^ Make changeslcorrections In RED ink, <br /> j,J ltd INFORMATION CHANGE(oats) <br /> l CWNERSHIP CHANGE(date)) <br /> OWNER FILE INFORMATION SSN I Fed Tax tD :5 r'I– sta IR I <br /> Owner to OW0013098 �Owner l0 •P..3eze)0-�1 L$tS:Srzn�ly <br /> Omer Name BOBZAMORA � ir ( y <br /> OwerDBA GO HYUNDAIKIA -,� na <br /> Omer rx�'1�c�rr1,C <br /> - <br /> Address 2929 AUTO CENTER DR <br /> STOCKTON, CA 95212 <br /> Home Phone Not Specified <br /> WorklBusiness Phone 209.838-1211 Wcj–q r) l <br /> PAailingAddress 2929 AUTO CENTER DR .C1. - v 655,-zCirr, <br /> STOCKTON,CA 95212mcac_�on I r <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility 11) FA0016202 <br /> Facility Name GO HYUNDAI KIA t :a u. 1 hn rr Li n!n 3 n <br /> Location 2929 AUTO CENTER DR �_ ;! ��., e-9 kf <br /> STOCKTON,CA 95212 <br /> Phone 209-838.1211 aL�—soo-14 <br /> Mailing Address 2929 AUTO CENTER DR <br /> STOCKTON,CA 95212 <br /> Careor <br /> Location Code 01 -STOCKTON At Phone <br /> BCS District 003-BESTOL.ARIDES Fax <br /> APN 12802019 EMait; Gt'L>oh�G ���usY,r.0 }r .COYYt <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name r- , <br /> Title <br /> Day Phone – L (_i/Z <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMA71ON <br /> Account ID AR0028325 New AecountlD: _ <br /> Mail Invoices to Owner M90 Invoices to: Owner Facility 1 Account <br /> Accoun,Name BOB ZAMORA jOrde one) <br /> Account Bunce as of 21212011: $0.00 <br /> rcnta One) <br /> Trwrw b AcWe4x acl�a <br /> PrograwEi nenl and Detail Recu dlD Empuyee lD and Name Slaws Owxef) Delete <br /> 2220-SM HW GEN<5 TONSIYR PRO527711 EBOOD4536-GARRETT BACKUS InactiveY N 1 D <br /> 2244-PACT TRANSFER RECORD-DES PRO524111 Inactive Y N A I D <br /> 2640-AST EXEMPT FAG <1,320 GAL PRO523282 EE0004636-GARRETT BACKUS Acdve,Exempt Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO527170 EECO04680-NATALIA SUBBOTN1KOActive Y N A I D <br /> aILUNGmdCOMPLIANCEACNNOWLEOGENIENT: r,the wdemagrm maim,open(ar"agent d same.ackramledgelket at sat andror gtaiNt Smile.PNS1EHDt-u7q enamm aasotlakd ,- lcis <br /> tadtlymadiaxy we ne heed tdtrepaM"adiaed as mowN do Uarula telco centtytvtMoperago:nlig ha pedoened in aew0anx vrilllau appicada OrblaM Coda enabr 5taldaads and <br /> Slaa,eWfrc Federal Laez. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFER '$25.00= Amount Paid Date_/I_ <br /> Water System to be TRANSFERED: Amount Paid Date_!/ <br /> Payment Type Check Number Race' d <br /> REHB: Date-:L—j L L Account out; _ Date <br /> CONMENTS: <br /> C7 nE5 d-s DES z/y/1� <br /> llah-env\envisionVepons15021.rpt -3 �A "?P)/ �,�,�A t <br />