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Date run 1/29/2014 11:06:54AI SAN Ji IN COUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Rur by a Pagel <br /> +i Facility Information as of 1/29/2014 <br /> Record Selection Cl Facility ID FA0021032 <br /> Make changes/corrections in RED ink. ++ 1-3o INFORMATION CHANGE(date) t !1 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID <br /> Owner ID OW0017310 New Owner ID <br /> Owner Name STEVEN VASQUEZ <br /> Owner DBA CHEMO'S AUTO REPAIR <br /> Owner Address 1131 E WASHINGTON ST <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-470-7669 <br /> Mailing Address 1131 E WASHINGTON ST <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0021032 10187739 <br /> Facility Name CHEMO'S AUTO REPAIR <br /> Location 820 S AMERICAN ST <br /> STOCKTON, CA 95206 <br /> Phone 209-470-7669 <br /> Mailing Address 820 S AMERICAN ST <br /> STOCKTON. CA 95206 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> Bos District 001 -VILLAPUDUA Fax <br /> APN 14729101 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 209-470-7669 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0037851 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name STEVEN VASQUEZ (Circle One) <br /> Account Balance as of 112912014: $128.50 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New OwneO Delete <br /> 1920-HMBP-Common Materials PRO536624 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO536769 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS/EHD hourly charges associated with this facility <br /> 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 Ordinance codes and/or Standards and State and/or <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Typ Che kf Number Rec by <br /> RENS: I f 1C7�) LI�C1 Date I 1 1' Account out: Date _1 1 <br /> COMMENTS', <br />