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Date run 10/9/2009 3:48:52P5 SAN JO,#^UIN COUNTY ENVIRONMENTAL HEAL"'T.DEPARTMENT Report 5021 <br /> Pagel <br /> Run by <br /> ^� Facility Information as of 10/9/20trs <br /> Record Selection Catena: Facility ID FA0010264 <br /> Make changes/corrections In RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008264 Case Number: H07525 New Owner ID <br /> Owner Name VINTAGE INVESTMENTS <br /> Owner DBA SATURN OF STOCKTON <br /> Owner Address 2991 AUTO CENTER CIR <br /> STOCKTON, CA 95212 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-956-9505 <br /> Mailing Address 2991 AUTO CENTER CIR <br /> STOCKTON, CA 95212 <br /> Care of VINTAGE INVESTMENTS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010264 <br /> Facility Name SATURN OF STOCKTON <br /> Location 2991 AUTO CENTER CIR <br /> STOCKTON, CA 95212 <br /> Phone 209-956-9505 <br /> Mailing Address 2991 AUTO CENTER CIR <br /> STOCKTON, CA 95212 <br /> Care of VINTAGE INVESTMENTS <br /> Location Code 01 -STOCKTON Aft Phone <br /> BOS District 003- BESTOLARIDES Fax <br /> APN 12802017 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017264 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner ! Facility / Account <br /> Account Name SATURN OF STOCKTON (Circle One) <br /> Account Balance as of 10/9/2009: $0.00 <br /> (Circle One) <br /> Transferto Activellnactve <br /> ProgromlElement and Description Record ID Employee ID anal Name Status New Owner) Delete <br /> 2220-SM HW GEN<5 TONSNR PR0514259 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512552 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0520181 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPRO510264 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATKPR0528219 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0522827 EE5555555-GarrettAlias-Backus —4miti B— Y N A e!fDe <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same.acknowledge Net 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 me OWNER on this form. I also certiry that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> Slate andior Federal Laws. <br /> APPLICANTS 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 Recei y <br /> RENS: B $o <br /> 7Date / / Account out: Date <br /> COMMENTS: /7 <br /> G 4��j(� l0/*Y1 ,e—e-'�L`„"z-, <br /> \\eh-envNen IsY iontreports15021.rpt <br />