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Date run 8/4/2015 10:35:18AM SAN JO JIN COUNTY ENVIRONMENTAL HEA" DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 8/4/2015 <br />Record Selection Criteria: Facility ID FA0009628 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />Owner ID <br />OW0007628 Case Number: H05012 <br />Owner Name <br />HILLIER, TODD; HILLIER, DAVID <br />Owner DBA <br />TOM HILLIER FORD <br />Owner Address <br />3000 MCHENRY AVE <br />209-838-3535 x <br />ESCALON, CA 95320 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-838-3535 <br />Mailing Address <br />3000 MCHENRY AVE <br />Y N <br />ESCALON, CA 95320 <br />Care of <br />APN <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0009628 10182807 <br />Facility Name <br />TOM HILLIER FORD <br />Location <br />3000 MCHENRY AVE <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete <br />ESCALON, CA 95320 <br />Phone <br />209-838-3535 x <br />Mailing Address <br />3000 MCHENRY AVE <br />4740 - WASTE TIRE SITE - EXEMPT <br />ESCALON, CA 95320 <br />Care of <br />Todd Hillier <br />Location Code <br />Y N <br />BOS District <br />005 - ELLIOTT, BOB <br />APN <br />24715042 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Todd Huller <br />Title <br />A <br />Day Phone <br />209-838-3535 <br />Night Phone <br />A <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0016628 <br />Mail Invoices to Account <br />Account Name TOM HILLIER FORD <br />Account Balance as of 8/4/2015: $0.00 <br />Program/Element and Description Record ID <br />1920 - HMBP-Common Materials <br />PR0520175 <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0511916 <br />2227 - GEN 5<25 TONS PERMIT <br />PR0517869 <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete <br />PR0501994 <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F <br />PR0509628 <br />2831 - AST FAC >/= 1,320 - <10 K GAL CUMULATIVE <br />PR0528217 <br />4740 - WASTE TIRE SITE - EXEMPT <br />PR0523296 <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG <br />PR0534304 <br />Noi`• pleo-be <br />cetAk-m '�Ow <br />Make changes/corrections in RED ink. <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 />Mail Invoices to: <br />Employee ID and Name <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />EE0002474 - MICHAEL PARISSI <br />EE0000000 - HAZ MAT SJC OES <br />EE0009001 - ELENA MANZO <br />EE0007289 - ALISON YOUNGBLOOD <br />EE0000000 - HAZ MAT SJC OES <br />EE0009001 - ELENA MANZO <br />EE0003611 - FRANK GIRARDI <br />pe rrius o� SPA . aofalZ5S;) <br />(Circle One) <br />Transfer to <br />Active/Inactve <br />Status <br />New Owner? <br />Delete <br />Active <br />Y N <br />A <br />I D <br />Inactive <br />Y N <br />A <br />I D <br />Active <br />Y N <br />A <br />I D <br />Inactive <br />Y N <br />A <br />I D <br />Inactive <br />Y N <br />A <br />D <br />Active <br />Y N <br />A <br />Cb D <br />Inactive <br />Y N <br />A <br />I D <br />Inactive <br />Y N <br />A <br />I D <br />pe rrius o� SPA . aofalZ5S;) <br />