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Date 211/2007 2:30:34PM SAN JO/'JUIN COUNTY ENVIRONMENTAL HEA' I DEPARTMENT Reponaso21 <br />Run by 4006 Pagel <br />"`� Facility Information as of 2/1/2007 <br />Record Selection Wine: Faddy ID FA0012811 <br />OWNER FILE INFORMATION <br />owner ID OW0009985 <br />Owner Name <br />GUTHRIE, DICK A <br />Owner DBA <br />J & D AUTO BODY INC <br />Owner Address <br />9786 TWIN CITIES RD <br />GALT, CA 95632 <br />Home Phone <br />209-339-0336 <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />9786 TWIN CITIES RD <br />GALT, CA 95632 <br />Care of <br />GUTHRIE, DICK A <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0012811 <br />Facility Name <br />J & D AUTO BODY INC <br />Location <br />400 N CLUFF AVE A <br />LODI, CA 95240 <br />Phone <br />Mailing Address 1011 S CHEROKEE LN <br />LODI, CA 952404305 <br />Care of DICK GUTHRIE <br />Location Code <br />BOB District 004 - SEIGLOCK, JACK <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0021499 <br />Mail Invoices to Facility <br />Account Name J & D AUTO DY INC <br />Account Balance as of 2/1/2007: $2 .00 <br />Program/Element and Descm6an Record ID <br />Mf/ <br />Employee ID and Name <br />Make changes/corrections In RED Ink or pencil. <br />INFORMATION CHANGE (dale) <br />OWNERSHIP CHANGE (date) _ <br />New Owner ID : <br />/t�LyrtiPIC 1u�11C <br />now - t�si <br />APN 04908064 <br />SIC Code <br />New Account ID: <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />Transfer ro (Circle One) <br />Pcevennaotve <br />Status New Ov neR Delete <br />2220 - SM HW GEN <5 TONS/YR PRO516797 EEOD00753 - WILLIE NG Active Y N A ( I <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO518857 EE00D0000 - HAZ MAT SJC OES Inactive Y N A D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARPRO516798 EE0000988 - KASEY FOLEY Inactive Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, are undersigned ovmer. operator or agent or same. admoviiedge hal all site, ardor project specific. PHSIEHD Murly Merges associated with this <br />faallly or aMvdy will be billed to the party Iden aged as Ne OWNER on this Iona. I also certify hal all operotrons will be peRormed in accordance wiN all applicable OrdMare Codes ardlor Standards and <br />Slate ardor Federal Laws. <br />APPLICANTS SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />RENS. <br />COMMENTS <br />llphs�hsgl-ntlappstenvisionstreportsl5021. rpt <br />Date <br />$20.00 = Amount Paid Date <br />' $372.00 = Amount Paid Date <br />Received ly <br />Date _/_/_ Account out: Date—LI-1-101 l D Z <br />