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Date run 91112045 8:33:42AM SAN JO " -U[N COUNTY ENVIRONMENTAL,HEAP —9 DEPARTMENT Report#5021Pagel <br /> Run by Facility Information as of 9/1/20017' <br /> Record Selection Criteria: Facility ID FA0015562 <br /> Make changes/corrections in RED ink or V�' . 1 <br /> INFORMATION CHANGE(dat6 <br /> an C OWNERSHIP CHANGE(date) <br /> NALM <br /> OWNER FILE INFORMATION <br /> Owner ID OW0012511 New Owner ID <br /> Owner Name EVER READY AUTO REPAIR <br /> Owner DBA <br /> Owner Address 1608 S ADELBERT AVE <br /> STOCKTON, CA 952157434 <br /> Home Phone 209-464-3020 <br /> WorkfBusiness Phone Not Specified <br /> Mailing Address 1608 ADELBERT AVE <br /> STOCKTON, CA 952157434 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015562 , I <br /> Facility Name EVER READY AUTO REPAIR !/ <br /> Location 1608 S ADELBERT AVE <br /> STOCKTON, CA 952147434 <br /> Phone 209-464-3020 <br /> Mailing Address 1608 S ADELBERT AVE <br /> STOCKTON, CA 952147434 <br /> Care of <br /> Location Code 99 - UNINCORPORATED AREA APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026862 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner f Facility f Account <br /> Account Name EVER READY AUTO REPAIR (Circle One) <br /> Account Balance as of 91112005: $50.00 <br /> (Circle fine) <br /> Transfer to Activellnacive <br /> ProgramlElement and Descnption Record ID Employee{D and Name Status New Owner? Delete <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PRO523061 EE0000988-KASEY FOLEY 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.PHSlEHD 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 al operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State andlor Federal Laws. <br /> AP'PLICANT'S SIGNATURE: Date ! ! <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date ! ! <br /> Water System to be TRANSFERED: "$558.00= Amount Paid Date / 1 <br /> Payment Type Check Number Received by <br /> REBS: R R . �4`� �- �.Cn t. pate�f�f� Account out: Date <br /> COMMENTS: , f <br /> A us <br /> 11phs-ehsgl-ntlappslenvisionslreports15021.rpt <br />