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Date run 2/3/2011 2:42:08PM SAN JOAN TIN COUNTY ENVIRONMENTAL HEAL'DEPARTMENT Report#5021 <br /> Run by 1273 Pagel <br /> Facility Information as of 2/3I201� <br /> Record Selection Criteria: Facility ID FA0010264 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008264 Case Number: H07525 New Owner ID <br /> Owner Name VINTAGE INVESTMENTS <br /> Owner DBA SATURN OF STOCKTON <br /> Owner Address 2991 AUTO CENTER CIR <br /> STOCKTON, CA 95212 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-956-9505 <br /> Mailing Address 2991 AUTO CENTER CIR <br /> STOCKTON, CA 95212 <br /> Care of VINTAGE INVESTMENTS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010264 <br /> Facility Name SATURN OF STOCKTON <br /> Location 2991 AUTO CENTER CIR <br /> STOCKTON, CA 95212 <br /> Phone 209-956-9505 <br /> Mailing Address 2991 AUTO CENTER CIR <br /> STOCKTON, CA 95212 <br /> Care of VINTAGE INVESTMENTS <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 003 - BESTOLARIDES Fax <br /> APN 12802017 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017264 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SATURN OF STOCKTON (Circle One) <br /> Account Balance as of 2/3/2011: $49.00 <br /> (Circle One) <br /> Transfer to Activellnaclve <br /> Programilaement and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 2220-SM HW GEN<5 TONSNR PR0514259 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512552 EEOOOOOOO-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0520181 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> UNIFIED PROGRAM FAC STATE SURCHARPR0510264 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2831 1AST FAC >/=1,320-<10 K GAL CUMULATKPR0528219 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 0-WASTE TIRE SITE-EXEMPT PR0522827 EE0004680-NATALIA SUBBOTNIKO'Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0534262 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 spec,PHS/EHD hourly charges associated with this <br /> 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 Ordinace Codes andlor Standards and <br /> State and/or Federal Laws. L <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 Recel <br /> REHS: Date_�/ /� Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />