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Datemn 11/2/201710:53:50AD SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report x5021 <br /> Run by Pagel <br /> Facility Information as of 11/2/2017 <br /> Record Selection Critena: Facility ID FA0000485 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) -7 <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 SSN/Fed Tax ID : y r 2 6 6 y 375- <br /> Owner ID OW0005718 New Owner ID : LLQ <br /> Owner Name BOKIDES FAMILY LTD f"tARS f4bcabd6 comp py <br /> Owner DBA <br /> OwnerAddress 1809 SCHOOL ST 3'33Y I N CC/-1 T P- 0190 <br /> MORAGA, CA 94556 PLrzA!i /,/T' MtLC cf� 9 HS 1 3 <br /> Home Phone Not Specified 912-f 3 0 b -3L!S Aj <br /> Work/Business Phone 209-334-0975 <br /> Mailing Address PO BOX 1411 <br /> WOODRIDGE, CA 95258 <br /> Care of AMIRI, HALEH <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0000485 10180605 <br /> Facility Name FLAG CITY CHEVRON <br /> Location 6421 CAPITOL AVE <br /> LODI, CA 95242 <br /> Phone 209-334-1873 x <br /> Mailing Address 6421 CAPITOLAVE <br /> LODI, CA 95242 <br /> Care of AMIRI,AZAD <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 004-WINN, CHARLES Fax <br /> APN 05532024 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION _ <br /> contact Name HALEH AMIRI A20 i) M 1 YL I <br /> Title OWNER ' A I uid M�/`I t1 <br /> Day Phone 209-334-1873 Z5 Wil <br /> Night Phone 209-481-8180 5'fi M e <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000484 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name FLAG CITY CHEVRON (Circle One) <br /> Account Balance as of 11/2/2017: $0.00 <br /> (Circle One) <br /> Transfer to Activelnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1615-RETAIL MKT 301-2000 SQ FT(PREPKGD/LTD PR PRO160308 EE0001084-STEPHANIE RAMIREZ Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO520517,/ EE0008709-JAMIE LIMA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0519074 EE0000030-AARON HANG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513125 EE000o000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PRO515536 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 2361 -UST FACILITY PR0231706 EE0000030-AARON HANG Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO507248 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0531406 Inactive Y N A I D <br /> ale FZ � � <br />