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Report#5021 <br /> FRun <br /> un 2/1/2007 2:28:48PM SAN JOOr1UIN COUNTY ENVIRONMENTAL HEAf "*,DEPARTMENT Pagel <br /> y 4006 Facility Information as of 2/1/200w- <br /> Record Selection Criteria: Factlily ID FA0014115 <br /> Make changes/corrections in RED IT or pencil. <br /> INFORMATION CHANG <br /> OWNERSHIP CHANG <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011726 New Owner <br /> Owner Name LOUIE J SCARES <br /> Owner DBA OLYMPIC TUNE <br /> Owner Address 1026 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 1026 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014715 <br /> Facility Name OLYMPIC TUNEy'o L p UL" <br /> Location 1026 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Phone 209-334-0617 <br /> Mailing Address 400 N CLUFF AVE <br /> LODI, CA 952400725 <br /> Care of <br /> Location Code APN: <br /> BOS District 004-SEIGLOCK, JACK SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025022 ( / New Account ID: <br /> Mail Invoices to Facility �I,y' Mail Invoices to: Owner / Facility / Account <br /> Account Name OLYMPIC T �p^✓r o (Circle one) <br /> Account Balance as of 2/1/2007: $2 .00 (CirdeOne) <br /> Transfer to Active/hractve <br /> PrograMElement and Description Record ID Employee ID and Name Status New amen Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0522234 EE0000753-WILLIE NG Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO521641 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,me undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHO hourly charges associated with this <br /> facility or activity will be billed to Me party identified as the OWNER on this form. I also certify that all operations Will be performed in accordance with all applicable Onimace Codes and/or Standards and <br /> State anNor 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 Received It <br /> REHS: Date / / Account out: Date �2—/ <br /> COMMENTS: <br /> ,j4 11t�Ve� if 0 o Al (�4� <br /> U o /-795 / �Q <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />