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Date ran 7/7/2008 10A&00AM SAN J/ ilUIN COUNTY ENVIRONMENTAL HEi 'H DEPARTMENT Report M21 <br /> Run by Paget <br /> Facility Information as of 7/7/20 <br /> Record Selecnon Colors: Farley ID FA0009138 <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 OW0007138 Case Number: H01479 New Owner ID <br /> Owner Name MANTECA AUTO PLAZA <br /> Owner DBA MANTECA AUTO PLAZA <br /> Owner Address 1190 S MAIN ST <br /> MANTECA, CA 95336 <br /> Home Phone Not Specked <br /> Work/Business Phone 209-239-7777 <br /> Mailing Address PO BOX 1286 <br /> MANTECA, CA 95336 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009138 <br /> Facility Name MANTECA AUTO PLAZA <br /> Location 1190 S MAIN ST <br /> MANTECA, CA 95336 <br /> Phone 209-239-7777 <br /> Mailing Address PO BOX 1286 <br /> MANTECA, CA 95336 <br /> Care of <br /> Location Code 04- MANTECA Alt Phone <br /> BOS District 005-ORNELLAS, LEROY Fax <br /> APN 22105023 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 AR0016138 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to. Owner I Facility I Account <br /> Account Name MANTECA AUTO PLAZA Qrcte ore, <br /> Account Balance as of 7/7/2008: $0.00 <br /> (Cede ores <br /> Transfer to Aniyennaclve <br /> Pmwam/Element end Dest;r"lon Record ID Employee ID and Name staW New Dw tern Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO513666 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511426 EE0000000-HAZ MAT SJC OES Inactive V N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO620995 EE0000000-HAZ MAT SJC DES Active y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO509138 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO522391 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I.the undersigned owner,operator or agent of same,acknowledge that all she.andfor project specihc.PMS/EHO houM charges asa xialed with this <br /> fadNly 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 /> Stale and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I / <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 I / Account out: Date <br /> COOAMNTS: <br /> \\ph s-ehsgl-nt\apps\envisions\reports\5021.rpt <br />