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Data run 1/252017 4:38:17PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report x5021 <br /> Run by <br /> Facility Information as of 1/25/2017 Pagel <br /> Record Selection Criteria: Facility ID FA0015913 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0020956 - New Owner ID <br /> Owner Name ,Jasvir Garcha <br /> Owner DBA <br /> OwnerAddress 15922 FOUR CORNERS CT <br /> LATHROP, CA 95330 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-215-4000 <br /> Mailing Address 15922 Four Corners Ct. <br /> Lathrop, CA 95330 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0015913 10706107 <br /> Facility Name Garcha Tires & Repair <br /> Location 1501 W Charter Way <br /> Stockton, CA 95206 <br /> Phone 209-215-4000 x <br /> Mailing Address 1501 W Charter Way <br /> Stockton, CA 95206 <br /> Care of Garcha Tires & Repair <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 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 AR0027682 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ,Jasvlr Garcha (Circle One) <br /> Account Balance as of 1/25/2017: $0.00 <br /> (Circe One) <br /> Transfer to Activeitnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0527156 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0540911 EE0000026-CESAR RUVALCABA Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523572 EE0009000-HARPRIT MATTU Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO533707 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACIRIOWtEDGEMENT: I,we undersigned owner,operator or agent of same,atlmowledge that all site,andor project specific,PHSfEHD hourly charges assoaated with this facility <br /> or activity,will be billed to the party identified as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date / / <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 /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: Invoice#: <br />