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Daterun 3/19/2015 ;10:57:59l SAN JOAQUIN COUNTY ENVIRONMENTAL FIEALTFI DEPARTMENTReport��ort <br /> Run byiFacility Information as of 3/1912015 Page1 <br /> Record selection Criteria: lity to FA0010766 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 OWNERSHIP CHANGE(date) <br /> SSN I Fed Tax ID <br /> Owner ID OW00Q8766 Case Number: H08684 New Owner ID <br /> Owner Name DAVID RAY <br /> Owner DBA SPECIALIZED TRUCK SVC <br /> Owner Address 3.665 E CHEROKEE RD <br /> STOCKTON, CA 95205 <br /> Horne Phone Not Specified <br /> Work/Business Phone 209-462-5078 <br /> Mailing Address. PO BOX 8403 <br /> STOCKTON, CA 952080403 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010766 10183801 <br /> Facility Name SPECIALIZED TRUCK SVC <br /> Location 3665 E CHEROKEE RD <br /> STOCKTON, CA 95205 <br /> Phone 209-462-5078 <br /> Mailing Address PO BOX 8403 <br /> STOCKTON, CA 952080403 <br /> Care of <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 002 - MILLER, KATHERINE Fax <br /> Al 13206009 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 AR0017766 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SPECIALIZED TRUCK SVC / � �7 (ciione) <br /> Account Balance as of 3/1912015: $0.00 <br /> (Circle One) <br /> Transfer to Activel <br /> Program/Element and Description Record ID Employee ID and Name Status Nl 've <br /> New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0520476 EE0008709-JAMIE DE LA ROSA Active Y N A �I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513054 EE0000000-HAZ MAT SJC OES Inactly€ Y N A D <br /> 2227-GEN 5<25 TONS PERMIT PR0514409 EED009488-JEFFREY WONG Active Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510766 EE0000000-HAZ MAT SJC OES Inactiv€ Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 CAL PR0528794 EED009488-JEFFREY WONG Inactiv€ Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PR0522961 EED009488-JEFFREY WONG Inactiv€ Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532118 Inactiv€ Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PFISIEFID hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and+'or Standards and State andtor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE Date / 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date I 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 / <br /> Payment Type Check Number Receiv�dly <br /> REHS: Dakefy✓�1� Account out: ll.•yy��jj Date 31 <br /> COMMENTS. r <br /> � �r(.�7 �f �c.,r- �^�-t� Cy-.�.�✓�� ii�P e4.'�t�---- 3'�/���5` <br /> 00 A'JC-- ; Dov z-0 <br />