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Date run 7/7/2008 10:00:26AM SAN JC 'JIN COUNTY ENVIRONMENTAL HEA' DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 7/7/20015 <br /> Record Selection Criteria: Facility ID FA0005604 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0004429 New Owner ID <br /> Owner Name VINTAGE INVESTMENTS <br /> Owner DBA TOYOTA TOWN INC <br /> Owner Address 2150 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-956-9505 <br /> Mailing Address 2150 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0005604 <br /> Facility Name TOYOTA TOWN <br /> Location 2150 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> Phone 209-473-2513 <br /> Mailing Address 2150 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 09406058 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 AR0006234 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name TOYOTA TOWN (Circle One) <br /> Account Balance as of 7/7/2008: $15.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0511897 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PR0507042 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2245-PACT TRANSFER RECORD-SUPPLEMENTPR0519768 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0502875 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPR0507043 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0522833 EE5555555-Garrett Alias-Backus Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,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 and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / <br /> Program Records to be TRANSFERED: `$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: "$372.00= Amount Paid Date / <br /> Payment Type Check Number Received by <br /> REHS: Date / Account out: Date <br /> COMMENTS. <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />