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E Report#5021 <br /> Date run , 9/12/2013 10:55:06AI SAN J[ IN COUNTY ENVIRONMENTAL HEA DEPARTMENT Pagel <br /> Run by Facility Information as of 9/12/2013 <br /> Record Selection Criteria: Facility ID FA0009349 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID <br /> I owner 11) OW0007349 Case Number: H03243 New Owner 1D <br /> Owner Name FRED J MINER JR <br /> Owner DBA .DIESEL PERFORMANCE INC <br /> Owner Address 2804 E FREMONT ST <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-946-0233 <br /> Mailing Address PO 13OX 8387 <br /> STOCKTON, CA 95208 <br /> Care of <br /> I FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility IDICERSID FA0009349.. 10,182,613 <br /> it Facility Name DIESEL PERFORMANCE INC <br /> i Location 2804 E FREMONT ST <br /> I STOCKTON, CA 95205 <br /> I Phone 209-946-0233 <br /> Mailing Address PO BOX 8387 <br /> STOCKTON, CA 95208 <br /> Care of <br /> Location Code 99'-UNINCORPORATED P Alt Phone 3 '3 — .6``' 39 <br /> SOS District 001 -VILLAPUDUA Fax �, '- 4 _831 i <br /> APN 14343001 EMail: t yj it .0 GJ S 61- to I� <br /> U <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name r 1 �� <br /> Title I I e r <br /> Day Phone & <br /> Night Phone '7 c <br /> 1 ACCOUNTS RECEIVABLE FILE INFORMATION <br /> i Account ID AR0016349 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility I Account <br /> Account Name DIESEL PERFORMANCE INC (Circle One) <br /> Account Balance as of 9/12/2013: $0.00 <br /> (Circle One) <br /> Transfer to ActiveAnactve <br /> Prograrn/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO519569 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511637 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2227-GEN 525 TONS PERMIT PR0513781 EE0009488-JEFFREY WONG- Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1184)-obsolete PRO501364 EE0000008-LETITIA BRIGGS InactivE Y N .A I D <br /> 2399-UNIFIED PROGRAM FAC STATE-SURCHARGE F PRO509349 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> : (2840 A5T EXEMPT"FAC<1,320 GAL —__PR0528343 EE0009488-JEFFREY'WONG------Activ_e,l Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP—PR0529448 "EE0009488=JEFFREYWONG—lnactivE' Y N A I D <br /> 4740-WASTE TIRE SITE-'EXEMPT PRO524079 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534595 Inactiv( Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specific,PHSIEHD 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 andlor Standards and State ancvor <br /> I Federal Laws, <br /> 2 1 <br /> V F GD[2 fi r <br /> I APPLICANT'S SIGNATURE: ! Date I I <br /> Program Records to be TRANSFERED: - "$25.00= Amount Paid Date 1 ! <br /> Water System to be TRANSFERED: Amount Paid Date / ! <br /> Payment Type Check Number Received y <br /> REHS: Date ! I Account out: Date�! I 13 <br /> COMMENTS:' _ • <br />