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Date run 8/28/2007 4:40:32Ph SAN JC IUIN COUNTY ENVIRONMENTAL HE,? H DEPARTMENT Report a5021 <br /> Run by 1.e i - <br /> PagelFacility Information as of 8/28/2007 <br /> Record Selection Criteria: Faculty ID FA0009714 <br /> Make changes/corrections In RED Ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0007714 Case Number: H05212 New Owner ID : <br /> Owner Name RONLY L ALCORIZA <br /> Owner DBA AUTOMEISTER <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-367-3521 <br /> Mailing Address 4290 E CHEROKEE RD <br /> STOCKTON, CA 952152219 C Y <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009714 I(,, (�� <br /> Facility Name AUTOMEISTER t <br /> Location 4290 E CHEROKEE RD <br /> STOCKTON, CA 95215 Y C) <br /> Phone 209-931-0550 <br /> Mailing Address 4290 E CHEROKEE RD <br /> STOCKTON, CA 952152219 <br /> Care of _ <br /> Location Code 99- UNINCORPORATED AREA APN:092-210-277 <br /> BOS District 002- RUHSTALLER, LARRY SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016714 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AUTOMEISTER (cirdeOne) <br /> Account Balance as of 8/28/2007: $50.00 <br /> (Cirde One) <br /> Transfer to AcWeJlnaMe <br /> Program/Element and Description Record ID 5pKyee 10 and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSIYR PRO514002 EE8888888-Ray Alias-von Flue cove Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512002 EE0000000-HAZ MAT SJC OES In c Ive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO519818 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR�PRO509714 EEOOO0000-HAZ MAT SJC OES Inactive Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PRO522962 EE9999999-Michelle Alias-Henry cove Y N A Q D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,aM/o ed sp 'c,PHS/EHD hourly charges associated with this <br /> facility or activity we be billed to the party identified as the OWNER on this fonn. I also certify that all operations will be performed in accordance with all ap licable Ord/nace Codes andlor Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date / / ,M <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date / ! <br /> Payment Type Check Number Race' ed by <br /> RENS: Date / / Account out: (7— D to <br /> COMMENTS: <br /> 03010-7 <br /> vo <br /> c6wuxc� <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />