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Date run 5/4/2011 11:57:56AM SAN Jf ')UIN COUNTY ENVIRONMENTAL HEP- --H DEPARTMENT Report#W21 <br /> Run by Pagel <br /> Facility Information as of 5/4/2l� <br /> Record Selection Coterie: Facility ID FA0018604 <br /> Make changes/conections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0015281 New Owner ID <br /> Owner Name VALDOVINOS, CARLOS <br /> Owner DBA <br /> Owner Address 8724 SAN PASQUAL WAY <br /> STOCKTON, CA 95210 <br /> Home Phone 209-298-5739 <br /> Work/BusinessPhone 209-948-2155 <br /> Mailing Address 8724 SAN PASQUAL WAY <br /> STOCKTON, CA 95210 <br /> Care of VALDOVINOS, CARLOS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018604 <br /> Facility Name JOSHUAS AUTO PARTS <br /> Location 738 E CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-948-2155 <br /> Mailing Address 738 E CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Care of VALDOVINOS, CARLOS <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16717004 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CARLOS VALDOVINOS <br /> Title (� <br /> Day Phone 209-298-5739 <br /> Night Phone 209-956-3867 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032951 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name JOSHUAS AUTO PARTS (Circle One) <br /> Account Balance as of 5/4/2011: $0.00 <br /> (Circle One) <br /> Transfer to Activennache <br /> Prgra itElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PR0527463 EE0001421 -STACY RIVERA Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0530629 EE0007379-AMANDA BOERTIEN Inactive Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0533439 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,to undersigned owner,operator or agent of same,acknowledge that all site.andlor project specific,PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the parry identified as the OWNER on tis form. I also catty that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards am <br /> State andfor Federal Laws. <br /> APPLICANTS 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 ck Number Recelv <br /> REHS: Date��/� Account out: Date <br /> COMMENTS: <br /> No H sf2 ov�er� v� i � � . <br /> \\eh-env\envisionVeports\5021.rpt O <br />