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Date run 3/3/2010 4:21:OOPM SAN JC UIN COUNTY ENVIRONMENTAL HEA I DEPARTMENT Report#5021 <br /> Run by .a/ �L Pagel <br /> Facility Information as of 3/3/2010 <br /> Record Selection Criteria: Facility 10 FAGO19858 <br /> Make changesicorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0016288 New Owner ID <br /> Owner Name WARE, IRENE <br /> Owner DBA BILL'S MUFFLER SHOP <br /> Owner Address 2410 W WILLOW <br /> STOCKTON, CA 95215 <br /> Home Phone 209-470-4084 <br /> Work/Business Phone Not Specified <br /> Mailing Address 2410 W WILLOW <br /> STOCKTON, CA 95215 <br /> Care of WARE, BILL <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019858 <br /> Facility Name BILLS MUFFLER SHOP <br /> Location 1807 E CHEROKEE RD 5 <br /> STOCKTON, CA 95205 <br /> Phone 209-470-4084 <br /> Mailing Address 1807 E CHEROKEE RD <br /> STOCKTON, CA 95205 <br /> Care of WARE, BILL <br /> Location Code 99-UNINCORPORATED P Alt Phone <br /> BOS District 002- RUHSTALLER, LARRY Fax <br /> APN 11910003 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name REASONABLE, WILLAIM <br /> Title MANAGER <br /> Day Phone 209-470-4084 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0035372 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name BILLS MUFFLER SHOP (Clrtle One) <br /> Account Balance as of 3/3/2010: $262.00 <br /> (Circle One) <br /> Transfer to Active/Inaotve <br /> Progrannd l ent d Description //M l 01+4fRecord ID Employee ID and Name Status New Owner? Delete <br /> -SM HW GEN<5TONS/YR PR0530487 EE0009488-JEFFREY WONG Active Y N A D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PRO530488 EE0009488-JEFFREY WONG Active Y N A D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0532311 Active Y N A j1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will ice billed to tihe party identified as the OWNER on this fiction. I also certify that all Operations will be performed in accordance with all applicable Ordmace Codes and/or Standards and <br /> Stale ardor Federal Laws. <br /> APPLICANTS SIGNATURE: Date / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date—JI <br /> Water System to be TRAN FERED: '$372.00= Amount Paid Date <br /> Payment TypeR k Number Receive y <br /> RENS: Date / / : ccount out: Date / /L <br /> COMMENTS: <br /> ,oOFOW <br /> \\eh-env\envision\reports\5021.rpt <br />