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Date me 2/11/2014 12:46:12PI SAN JO 7IN COUNTY ENVIRONMENTAL HEAL 1%WDEPARTMENT Report#5021 <br /> �r <br /> Run by Facility Information as of 2/11/2014 Pagel <br /> Record Selection Criteria: Facility ID FA0020345 <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 OW0016703 New Owner ID <br /> Owner Name PETER NASH <br /> Owner DBA EASY FUEL <br /> Owner Address 1346 E TAYLOR ST <br /> SAN JOSE, CA 95133 <br /> Home Phone Not Specified <br /> Work/Business Phone 408-280-5235 <br /> Mailing Address 1346 E TAYLOR ST <br /> SAN JOSE, CA 95133 <br /> Care of <br /> a <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0020345 10,187,575 <br /> Facility Name EASY FUEL <br /> Location 2420 E EIGHT MILE RD <br /> STOCKTON, CA 95210 <br /> Phone 408-280-5235 x0 <br /> Mailing Address 1346 E TAYLOR ST <br /> SAN JOSE, CA 95133 <br /> Care of <br /> Location Code 99-UNINCORPORATED P Alt Phone <br /> BOS District 002-RUHSTALLER, LARRY Fax <br /> APN 12002014 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name PETE NASH <br /> Title DIR PURCHASING <br /> Day Phone 408-280-5235 <br /> Night Phone 408-802-0192 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0036332 NewAccount ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name PETER NASH (Circle One) <br /> Account Balance as of 2/11/2014: $ 268 6d-- <br /> (Circle One) <br /> Transferto Acti nactve <br /> Program/Element and Description Record ID Employee ID and Name Status w OwneR tete <br /> 1921 -HMBP-Regular-Primary Location PRO535230 EE0006044-LOWELL ALLEN Active N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO538604 EE0004636-GARRETT BACKUS Active N A I D <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PRO536578 EE0004636-GARRETT BACKUS Active N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO535263 Inactiv[ N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project specific,PHSIEHD hourly charges associated with thisfacility <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 andor Standards and State sector <br /> Federal Laws <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date I / <br /> Water System to be TRANSFERED: Amount Paidate / ! <br /> Payment Type Check Number Recei y <br /> REHS: Date��/�L/ Account out: Date <br /> COMMENTS: <br /> �o�e 19 y/ Z220 � 2`63 y- �o FAOD/240 <br />