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Date run 4/29/2010 2:50:40PN SAN Jd )UIN COUNTY ENVIRONMENTAL HE)' '-I DEPARTMENT Report#5021 <br /> Run by � Pagel <br /> Facility Information as of 4/29/2010 <br /> Record Selection Criteria: Facility ID FA0018142 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014885 New Owner ID <br /> Owner Name RON DAHNKE <br /> Owner DBA GALT SUPER LUBE <br /> Owner Address 25533 N HWY 99 FRONTAGE RD <br /> ACAMPO, CA 95220 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-333-0198 <br /> Mailing Address 25533 N HWY 99 FRONTAGE RD <br /> ACAMPO, CA 95220 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018142 <br /> Facility Name GALT SUPER LUBE <br /> Location 25560 N HWY 99 <br /> ACAMPO, CA 95220 <br /> Phone 209-366-2213 x0 <br /> Mailing Address 25533 N HWY 99 FRONTAGE RD <br /> ACAMPO, CA 95220 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name RON DAHNKE <br /> Title <br /> Day Phone 209-333-0198 <br /> Night Phone 209-366-2213 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0031912 New Account ID <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name RON DAHNKE (Circle One) <br /> Account Balance as of 4/29/2010: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/ lerpf escription Record ID Employee ID and Name Status New Owner? Delete <br /> SM HW GEN<5 TONS/YR PR0527364 EE0001422-ARIS CACAPIT Active Y N A I D <br /> PACT TRANSFER RECORD-OES PRO526785 Active Y N A I D <br /> ER$�S -EL CTRONIC REPORTING SURCHARGE_P�R0055331�91/6/,�/� Active Y N A I D <br /> oBILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned'bv71Se7,bpArator 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 /> State and/or Federal Laws. <br /> APP'LICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Receive _ <br /> REHS: AC 11f ill- Date / �I / t0 Account out: Date _/ !� <br /> COMMENTS: <br /> kb 1TV 14W IN 90 <br /> \\eh-env\envision\reports\5021.rpt <br />