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Report SW21 <br />Date mn 5/23/2005 8:19:58AR SAN JOI' COUNTY ENVIRONMENTAL HEALT" DEPARTMENT Pagel <br />Run by 4006 .,. Facility Information as of 5/23/20Dtr <br />Record Selection Cmeda: Faciray, ID FA001 X69 <br />Make chaINFORMATI N C in RED ink e) pens . <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION +�'! <br />owner ID <br />OW0012518 <br />Owner Name <br />SALAZARS QUALITY TRUCK WORKS <br />owner DBA <br />SALAZAR'S QUALITY TRUCK WORKS <br />Owner Address <br />4720 CAYMAN CT <br />STOCKTON, CA 95210 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-466-4090 <br />Mailing Address 4720 CAYMAN CT <br />STOCKTON, CA 95210 <br />Care of <br />FACILITY FILE INFORMATION <br />FacilityID FA0015569 <br />Facility Name SALAZARS QUALITY TRUCK WORT <br />Location 1622EALPINEAVE rSTOCKTON, CA 952052525 <br />Phone 209-466-4090 <br />Mailing Address <br />STOCKTON, CA 95210 <br />Care of <br />Location Code 99 - UNINCORPORATED AREA <br />BOS District <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0026869 <br />Mail Invoices to Gwnef— <br />Account Name SALAZARS QUALITY TRUCK WORKS <br />Account Balance as of 5/23/2005: $0.00 <br />Program/Element and Description Record ID Employee ID and Name <br />New Owner ID : <br />vBo� ga3b <br />SIC Code:9900 <br />New Account ID: <br />Mail Invoices to: Owner / (Facility) Account <br />(Circle One) <br />(Circle One) <br />Transferto Achve4nactve <br />Status New Owner! Delete <br />2220 - SM HW GEN <5 TONS/YR PRO523833 EE0008373 - JOHN JACKSON Active Y N A I D <br />2244 - PACT TRANSFER RECORD - DES PRO523433 EEOOD0000 - HAZ MAT SJC DES Active Y N A I D <br />3122 - STORMWATER INSPECTION - AUTO SHOP PRO523068 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, 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 Ordinate Codes and/or Standards and <br />State and/or Federal Laws.f/ ! <br />APPLICANTS SIGNATURE: I f lH t L�`-� D� / I ! Date �l IFI 0,S -- <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS <br />5 k� <br />\\phs-ehsq I-nt\apps\envisions\reports\5021. rpt <br />' $20.00 = Amount Paid <br />' $155.00 = Amount Paid _ <br />Date I / Account out: <br />Date <br />Date / <br />Received by <br />Date <br />