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Data ran 10/18/2016 3:53:57P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 10/18/2016 <br /> Record Selection Criteria: Facility ID FA0012730 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0009916 New Owner ID <br /> Owner Name MICHAEL SHUEMAKE <br /> Owner DBA CENTRAL VALLEY TRAILER REPAIR <br /> OwnerAddress 2606 S RAILROAD AVE <br /> FRESNO, CA 93725 <br /> Home Phone Not Specified <br /> Work/Business Phone 559-233-8444 <br /> Mailing Address 2606 S. RAILROAD AVE <br /> FRESNO, CA 93725 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0012730 10184331 <br /> Facility Name CENTRAL VALLEY TRAILER REPAIR INC <br /> Location 781 SWIFT WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-941-8444 x <br /> Mailing Address 781 SWIFT WAY <br /> STOCKTON, CA 95206 <br /> care of SOVENYASUNTHORN <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 16326003 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021248 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name FAYE Z (Circle One) <br /> Account Balance as of 10/18/2016: $0.00 <br /> (Circle One) <br /> Transfer to Actau1nactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 1921 -HMBP-Regular-Primary Location PR0521082 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0516666 EE9999998-ONE VACANTI Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0517561 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2 UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0516667 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 83 LASTFAC 10 K-</=100 K GAL CUMULATIVE PRO528344 EE9999998-ONE VACANTI Active Y N A (:]!�) D <br /> C-ELECTRONIC REPORTING STATE SURCHARGI PR0532072 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andror project spec,PHSIEHD hourly charges associated win,this facility <br /> or activity will be billed tome Party identified as the OWNER an this ffooran.,I.also certify that tthh�atalall op�errations/will be <br /> Fertorned in accordance with all applicable Orrdiiin�a_ncce]CCodes andor Standards and State andor <br /> Y1 <br /> Federal Lews.A (/( <br /> APPLICANTS 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 teck Number Received/b�j /// <br /> EHD S Date_�/ / Account out: ✓/J Date 1 l /Y <br /> COMMENTS: <br /> Invoice#: <br />