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Datewun. C.!3/2008 4:02:26PM SAN J( UIN COUNTY ENVIRONMENTAL HEA i DEPARTMENT Report#5021 <br />Run by 1278 Pagel <br />Facility Information as of 6/3/20L)0 <br />Record Selection Criteria: Facility ID FA0009564 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0007564 <br />Owner Name <br />WONG, BILLY <br />Owner DBA <br />WONG'S DIESEL SERVICE <br />Owner Address <br />1856 N BROADWAY AVE <br />Y <br />STOCKTON, CA 952053060 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-937-0638 <br />Mailing Address <br />1856 N BROADWAY ST <br />A I D <br />STOCKTON, CA 95205 <br />Care of <br />Inactive <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0009564 <br />Facility Name <br />WONGS DIESEL SERVICE <br />Location <br />1856 N BROADWAY AVE <br />N <br />STOCKTON, CA 95205 <br />Phone <br />209-937-0638 x0 <br />Mailing Address <br />1856 N BROADWAY ST <br />State and/or Federal Laws. <br />STOCKTON, CA 95205 <br />Care of <br />Location Code 01 - STOCKTON <br />BOS District 001 - GUTIERREZ, STEVE <br />APN 14325003 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0016564 <br />Mail Invoices to Owner <br />Account Name WONG, BILLY <br />Account Balance as of 6/3/2008: $0.00 <br />Program/Element and Description Record ID Employee ID and Name <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Owner? Delete <br />2220 - SM HW GEN <5 TONS/YR PRO513903 <br />EE0008317 - RAYMOND VON FLUE <br />Inactive <br />Y <br />N <br />A I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0511852 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A I D <br />2244 - PACT TRANSFER RECORD - OES PR0519728 <br />EE0000000 - HAZ MAT SJC OES <br />Active <br />Y <br />N <br />A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHAR1PR0509564 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A I D <br />4740 - WASTE TIRE SITE - EXEMPT PR0524495 <br />EE0004045 - TED TASIOPOULOS <br />Active <br />Y <br />N <br />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 <br />associated with this <br />facility or activity will be billed to the party identified as the OWNER on this form. I also <br />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: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />RENS: <br />Date <br />* $20.00 = Amount Paid Date <br />* $372.00 = Amount Paid Date ! / <br />Re cei e y <br />v V <br />Date Account out: �+- D/atte/ <br />/ <br />COMMENTS: \lD F � F"/4y6-/LAlD <br />\\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />