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Dat=rvi 8/31/2011 345:02PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report M5021 <br />Rm by Pagel <br />Facility Information as of 8/31/2011 <br />I-Auueusao <br />OWNER FILE INFORMATION <br />Omer ID <br />OW0016703 <br />Owner Name <br />PETER NASH <br />Omer DBA <br />EASY FUEL <br />Owner Address <br />1346 E TAYLOR ST <br />408-280-5235 x0 <br />SAN JOSE, CA 95133 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />408-280-5235 <br />Mailing Address <br />1346 E TAYLOR ST <br />SAN JOSE, CA 95133 <br />Care of <br />APN <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0020345 <br />Facility Name <br />EASY FUEL <br />Location <br />2420 E EIGHT MILE RD <br />STOCKTON, CA 95210 <br />Phone <br />408-280-5235 x0 <br />Mailing Address <br />1346 E TAYLOR ST <br />SAN JOSE, CA 95133 <br />Care of <br />Location Code <br />BOS District <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Tifle <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0036332 <br />Mail Invoices to Owner <br />Account Name PETER NASH <br />Account Balance as of 8/31/2011: $0.00 <br />Progradd0emem acd Oesm im <br />Record ID Employee ID and Name <br />2244 -PACT TRANSFER RECORD -DES PRO535230 <br />ERSC - ELECTRONIC REPORTING STATE SURCHPRO535263 <br />Make changes/corrections in RED Ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID <br />Alt Phone <br />Fax <br />EMail : <br />New Account ID: <br />Mail Invoices to: Owner / Facility / Account <br />(Circle Orel <br />(Circls Ona) <br />Transfer to Adlvellnactve <br />Status New Owrer9 Delete <br />Active Y N A 1 D <br />Active Y N A I D <br />BILLING air COMPLIANCE ACKNOWLEDGEMENT'. 1, the mdersigred owner, operator or egam or "me, aol mwledge that ell site, andlor project specifiq PHSEHD hourly charges associated with this <br />facility or acovdy will be billed to the party identified as the OWNER on this form. I also certify that all operation wifl be performed in accordance with all applicable Ordinate Codes and/or Standards and <br />State aMlor Federal Laws. <br />APPLICANTS SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date / I <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Type Check Number Racal <br />REHS: Date Z 131 / / Account out• Date i% <br />COMMENTS <br />\\eh-env\envisim\reports\5021.rpt <br />