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Date nun 1/6/2005 11:16:50AN SAN 30 UIN COUNTY ENVIRONMENTAL HEAr 'I DEPARTMENT Report#5021 <br /> Run by liaiii 3r <br /> Pagel <br /> Facility Information as of 1/6/200 <br /> Record Selection Cmena: Facility ID FA0010042 <br /> Make changes/corrections in RED Ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011689 Ne er ID <br /> Owner Name LO, FENG C G/l/IIP / <br /> Owner DBA ALL TUNE AND LUBE <br /> Owner Address ^"2J><;en rlo <br /> STOCKTON, CA 95206 4eak , 6A q6,;,-Yo <br /> Home Phone 209=234.6694 7p11-333-(0�3 / <br /> Work/Business Phone 209-333-6290 <br /> Mailing Address 21-2g-R1$q.0 R d 3 S Men LLC- J-k <br /> STOCKTON, CA 95206 L e 5a D <br /> Care of FENG C LO <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010042 <br /> Facility Name ALL TUNE AND LUBE <br /> Location 923 S CHEROKEE LN <br /> LODI, CA 95240 <br /> Phone 209-333-62QO 333 'IeA3µ <br /> Mailing Address 2129-14S ,^„R L LV <br /> STOCKTON, CA 95240 GA 25,220 <br /> Care of FENG C LO <br /> Location Code 02 - LODI APN:047-390-06 <br /> BOS District 004 -SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017042 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ALL TUNE AND LUBE (Circle One) <br /> Account Balance as of 1/6/2005: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Elementand Description Record ID Employee ID and Name Status New Owners Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO514141 EE0008389-DENNIS CATANYAG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512330 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0522273 Active Y N A 1 D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPRO510042 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or pmject specific,PHS/EHD hourly charges associated yeah this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certgy that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date / I <br /> Payment Type Check Number Received b <br /> REHS: Date I I Account out: Date l 042/ P <br /> COMMENTS: <br /> mer DSS <br /> \\phs�hsgl-nt\apps\envisions\reports\5021.rpt <br />