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Date run 9/4/2018 3:10:10PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/4/2018 <br /> Record Selection Criteria: Facility ID FA0009610 <br /> Make changes/corrections in RED ink. /� <br /> INFORMATION CHANGE(date) V 49 <br /> OWNERS//HIP CHANGE(d/ate) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID : 0I4 ZL) (U ICD Z <br /> Owner ID OW0007610 Case Number: H04967 New Owner ID : <br /> Owner Name LOPEZ, JAIME GIC" I CI Rc>c " u rZ <br /> Owner DBA LOPEZ TRUCK&TRAILER REPAIR ,U a1.1(11 GAY/ trA k Dnj -e-Y )/_e1PC_J Y <br /> OwnerAddress 4800 E WATERLOO RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-649-8532 2,(,,,;,24 <br /> Mailing Address 4800 E WATERLOO RD <br /> STOCKTON, CA 95215 <br /> Care of LOPEZ, JAIME 1i1 (.(CZ O r V+ va" <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009610 <br /> Facility Name LOPEZ TRUCK &TRAILER REPAIR i l CGS �tY ilzt,I eY <br /> Location 4800 E WATERLOO RD <br /> STOCKTON, CA 95215 <br /> Phone 209-649-8532 ) <br /> Mailing Address 4800 E WATERLOO RD <br /> STOCKTON, CA 95215 <br /> Care of LOPEZ, JAIME GJ D )i;( u;t z <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 002 - MILLER, KATHERINE Fax <br /> APN 101-021-23 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION _ <br /> Contact Name Jav i?r �'U VGl �C�i (,{p1Gj OdVjC�I LIZ <br /> Titleiq <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION f�A+ I e_0.s + 2 ��— l4 Z0 <br /> AccountlD AR0016610 NewAccountlD: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name LOPEZ TRU &TRAILER REPAIR (Circle One) <br /> Account Balance as of 9/4/2018: $- .00 /rye DD�(��7 <br /> 1 (Circle One) <br /> Transfer to Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 61�945192 N BP-Reqular-Primary Location PR0519769 EE0008709-JAMIE LIMA Inactive Y N I D <br /> 2220-SM HW GEN <5 TONS/YR PR0513926 EE9999998-ONE VACANT1 Inactive Y N I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511898 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0231762 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509610 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PR0522981 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0540191 EE0009000-HARPRIT MATTU 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 facility <br /> 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 Ordinance Codes andlor Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: "— I Date v/�1 / 0 / / <br /> Program Records to be TRANSFER/D: *$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by �( <br /> EHD Staff: ec Date�/ / Account out: b6 Date 1=2— / I V <br /> COMMENTS: <br /> Invoice#: <br />