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Date run 7/7/2008 10:04:27AM SAN JO 1N COUNTY ENVIRONMENTAL HEA' DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/7/2008 <br /> Record Selection Criteria: Facility ID FA0010988 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008988 Case Number: H09107 New Owner ID <br /> Owner Name STAN MORRI <br /> Owner DBA STAN MORRI FORD <br /> Owner Address 3500 AUTO PLAZA WAY <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-4821 <br /> Mailing Address 3500 AUTO PLAZA WAY <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010988 <br /> Facility Name STAN MORRI FORD <br /> Location 3500 AUTO PLAZA WAY <br /> TRACY, CA 95304 <br /> Phone <br /> Mailing Address 3500 AUTO PLAZA WAY <br /> TRACY, CA 95304 <br /> Care of <br /> Location Code 03 -TRACY Alt Phone <br /> BOS District 005 - ORNELLAS, LEROY Fax <br /> APN 21227002 EMaV <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017988 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name STAN MORRI FORD (Circle One) <br /> Account Balance as of 7/7/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514484 EE0005642-MICHELLE HENRY Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOfPR0513276 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520590 EE0000000-HAZ MAT SJC CES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0510988 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0522404 EE0004045-TED TASIOPOULOS Active 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 /> State and/or Federal Laws. <br /> APPLICANT'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 Received by <br /> REHS: Date / / Account out: Date / <br /> COMMENTS. <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />