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Daterun 3/25/2014 3:57:43PK SAN 1 JUIN COUNTY ENVIRONMENTAL HEP- -1 DEPARTMENT Report asoz, <br /> Run by . Pagel <br /> Facility Information as of 3/25/24 <br /> Rewnd selection Cmena: Facility ID FA0019886 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> 3�2 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0017297 New Owner ID <br /> Owner Name VALDOVINO, SINDY E <br /> Owner DBA JOSHUAS DISCOUNT AUTO PARTS WH — <br /> Owner Address 411 S STANISLAUS ST 6201 — <br /> STOCKTON, CA 95203 <br /> Home Phone 209-513-5977ZiG — <br /> Work/Business Phone 209-688-3961 ..1�r� <br /> Mailing Address 738 E DR MARTIN LUTHER KING JR BLVD I.rliS <br /> Cam of — <br /> STOCKTON, CA 95206 L — <br /> — <br /> FACILITY FILE INFORMATION �}U5� 5�E-- ((cry) <br /> Facility ID/CERS ID FA0019886 10,187,405 — <br /> Facility Name JOSHUAS DISCOUNT AUTO PARTS WARD <br /> Location 845 E HAZELTON AVE �i5 (n}Gl3f2eD <br /> STOCKTON, CA 95203 <br /> Phone 209-513-5977 ( y�iE1 _ 4I/J �n�� <br /> Mailing Address 738 E DR MARTIN LUTHER KING JR BLVD _ <br /> STOCKTON, CA 95206 II1ccv,(C;4 , — <br /> careof VALDOVINO, SINDYF%�/ — <br /> Location Code 01 -STOCKTON <br /> Bos District 001 -VILLAPUDUA Fax <br /> APN 14927056 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION�\� r <br /> Contact Name <br /> Title �\ <br /> Day Phone <br /> Night Phone � n� <br /> ACCOUNTS RECEIVABLE FILE INFORMATION (11 t I(J � <br /> Account ID AR0035437 \/ New Account ID: _ <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name JOSHUA DI OUNT AUTO PARTS WAREHSE (Circle One) <br /> Account Balance as of 3/25/2014: 5 0 <br /> (Circle One) <br /> Transfer to ActiveMadve <br /> PrograrNElement and Description Record ID Employee ID and Name status New OwneR Delete <br /> 1921 - BP-Regular-Primary Location PRO530830 EE0009817-ROBERT LOPEZ Active Y NA D <br /> HW GEN<5 TONS/YR PR0530869 EE0001421 -STACY RIVERA Active Y N D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0531123 EE0001421 -STACY RIVERA Aclive,I Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0530639 EE0007379-AMANDA BOERTIEN Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532374 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEME the and Igned owner,op ator or agent of same,acknowledge that all site,andor project specifo,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to chs perry iaenl'Arotl e e OWNER s fomt I also iy that all operations will be performed in aceordanw with all applicable Ordinance Codes andor Standards 9"State ardor <br /> Federal Laws. <br /> APPLICANTS SIGNATOR . Date: /�� <br /> Program Records to be TRANSFEREO: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Race! -7 <br /> RENS: /'v'r> 10664� - DateS / 2,5 / /4- Account out: Date_/ / <br /> COMMENTS: Z. , /I <br />