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Date run 11/19/2013 1:28:39F SAN JOA N COUNTY ENVIRONMENTAL HEAL- )EPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/19/2013 <br /> Record Selection Criteria: Facility ID FA0010424 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008424 Case Number: H08065 New owner ID <br /> Owner Name JOHN W CHASE <br /> Owner DBA CHASE CHEVROLET <br /> Owner Address 6441 HOLMAN RD <br /> STOCKTON, CA 95212 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-475-6600 <br /> Mailing Address PO BOX 8349 <br /> STOCKTON, CA 95208 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010424 10,183,547 <br /> Facility Name CHASE CHEVROLET <br /> Location 6441 HOLMAN RD <br /> STOCKTON, CA 95212 <br /> Phone 209-475-6600 <br /> Mailing Address PO BOX 8349 <br /> STOCKTON, CA 95208 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 12803006 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 AR0017424 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name JOHN W CHASE (Circle One) <br /> Account Balance as of 11/19/2013: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520311 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512712 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2229-GEN 50<250 TONS PERMIT PRO514322 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2332-EXEMPT TANK FACILITY PR0535041 EE0004636-GARRETT BACKUS Active,l Y N A I D <br /> UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510424 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 284 AST EXEMPT FAC <1,320 GAL PR0528222 EE0004636-GARRETT BACKUS Active,l Y N A I D <br /> 4 40-WASTE TIRE SITE-EXEMPT PR0522795 EE0009000-HARPRIT MATTU Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531261 Inactive 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 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 and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Recej e <br /> REHS: Date Account out: Date l��l <br /> COMMENTS: <br />