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Date run 2/27/2015 8:52:19Ah SAN JI".,,JIN COUNTY ENVIRONMENTAL HEA.`w DEPARTMENT Report C5021 <br /> Run by Pagel <br /> Facility Information as of 2127/2015 <br /> Record Selection Criteria: Facility ID FA0005626 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN/Fed Tax ID : <br /> Owner ID OW0004451 New Owner ID <br /> Owner Name SANBORN CHEVROLET INC <br /> Owner DBA SANBORN CHEVROLET INC <br /> Owner Address 1210 S CHEROKEE LN <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-334-5000 <br /> Mailing Address PO BOX 1057 <br /> LODI, CA 95241-1057 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0005626 10181899 <br /> Facility Name SANBORN CHEVROLET INC <br /> Location 1210 S CHEROKEE LN <br /> LODI, CA 95241 <br /> Phone 209-334-5000 x <br /> Mailing Address PO BOX 1057 <br /> LODI, CA 95241-1057 <br /> Care of richard Sanborn <br /> Location Code 02- LODI Alt Phone <br /> SOS District 004-WINN, CHARLES Fax <br /> APN 04728013 Eli <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone / <br /> Night Phone V l� <br /> ACCOUNTS RECEIVABLE FILE INFORMATION�n <br /> Account ID AR0006259 U v New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SANBORN C ROLET INC (circle One) <br /> Account Balance as of 2/27/2015: $2, 7.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> Pmghtrn/Elemenl and Description Record ID Employee ID and Name Status New OwrroR Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519414 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> -HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511429 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2227 GEN 5<25 TONS PERMIT PRO505935 EE0001422-ARIS VELOSO Active Y N A I D <br /> 1 -UST FACILITY(BEFORE 1/84)-obsolete PRO602946 EE0000005-FATINAH ZAREEF Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO507602 EE0000005-FATINAH ZAREEF Inactive Y N I D <br /> AST EXEMPT FAC <1,320 GAL PR0528318 EE0001422-ARIS VELOSO Inactive Y I D <br /> 474 -WASTE TIRE SITE-EXEMPT PRO522805 EE0002622-BENJAMIN ESCOTTO Active Y N I D <br /> ERSC-ELECTRO�N�IICyREPORTI�G, TESURC 0532289 Inactive Y N A I D <br /> BILLING an M I/WQ CE A KN WWIL DO NT: I,t der ig W owner,opera r or agent of same,acknowledge that all site,anclor project specific,PHS/EHO hourly charges associated with this facility or; <br /> a bi the party identified as the OWNER this for I also codify that all operali s will be performed in accordance with all applicable Ordinance Codes anNor Standards and State anWw Federal Laws. <br /> p`I►,,tQ 6 jut (�Q 44 �paS v' *1`} <br /> APPL ANTS SIGNATOR 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 Received b <br /> REHS: /CJ's l`C L 1, Date il'`/moi/.� Account out: Date <br /> COMMENTS: <br />