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Date run 12/18/2008 10:22:57/ SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 12/18/20 <br />Record Selection Critena: Facility ID FA0014598 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0011615 <br />Owner Name <br />RED'S APPLIANCE CENTER <br />Owner DBA <br />REO'S APPLIANCE CENTER <br />Owner Address <br />7 W OAK ST <br />LODI, CA 95240 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />7 1/\/ OAK ST <br />LODI, CA 95240 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0014598 <br />Facility Name <br />REO'S APPLIANCE CENTER <br />Location <br />7 W OAK ST <br />LODI, CA 95240 <br />Phone <br />Mailing Address <br />7 y\/ OAK ST <br />LODI, CA 95240 <br />Care of <br />REO'S APPLIANCE CENTER <br />Location Code <br />BOS District <br />004 - VOGEL, KEN <br />APN <br />04303613 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <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 />Contact Name REGIS APPLIANCE CENTER <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0024841 New Account ID: <br />Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br />Account Name REO'S APPLIANCE CENTER (Circle One) <br />Account Balance as of 12/18/2008: $0.00 <br />(Circle One) <br />Transfer to Active/Inache <br />Program/Element and Description Recard ID Employee ID and Name Status New Owner? Delete <br />2217 -APPLIANCE RECYCLER PR0521499 EE0002670- MUNIAPPA NAIDU 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 <br />facility 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 andtor Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS <br />\\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />" $20.00 = Amount Paid <br />" $372.00 = _ Amount Paid <br />Date / / Account out: <br />Date <br />Date <br />Date <br />Received by <br />Date <br />