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ste ran Z115/2011 3:12:49Ph SAN JOAOUIN COUNTY ENVIRONMENTAL HEAL"I DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/15/20rK <br /> Record Selection criteria: Facility ID FA0009046 <br /> Make changeslcorrections INFORMATION CIHANGEn RED I <br /> WILEINFORMATION <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> SSN/Fed Tax ID <br /> Owner ID OW0007046 Case Number: H00623 New Owner ID <br /> Owner Name FRANK BROCKMAN <br /> Owner DBA CALIFORNIA RADIATOR WORKS <br /> Owner Address 328 S CALIFORNIA ST <br /> STOCKTON, CA 952033502 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-948-0746 <br /> Mailing Address 32 C e-;i Q;*&cST 5 c� <br /> Care of l <br /> TOCKZO IC 9=203 MKC N (Z CL to <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009046 <br /> FacilityName CALIFORNIA RADIATOR WORKS <br /> Location 328 S CALIFORNIA ST <br /> STOCKTON, CA 952033520 <br /> Phone 209-465-9118 <br /> Mailing AddressLIFORNIA ST �` C cil <br /> STOeKT4)N_,CA 952n3 F,____02 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 14909515 EMaiI: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name BRIAN DINGMAN <br /> Title MANAGER <br /> Day Phone 209-465-9118 <br /> Night Phone 209-464-0843 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016046 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CALIFORNIA RADIATOR WORKS (Circle Ori <br /> Account Balance as of 2/15/2011: $547.00 <br /> (Clmle Dan) <br /> Transfer to Activalmadve <br /> Progra"Element and Description Record ID Employee ID and Name status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PRO513606 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511334 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PR0514519 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0519345 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR PR0509046 EEo000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0531459 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific,PHSIEHD hourty charges associated with this <br /> facility or activity will be taRed to the party identified as the OWNER on Nis form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State andror Federal Laws. 1 o \\ (\ 1 <br /> APPLICANTS SIGNATURE: S P_� \NAt1 C�.J9.X �I'a-`�V-�� •�"¢-➢ ZIL14 Date Z- / \tA, <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date Z/ k5 / III, <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />