Laserfiche WebLink
Date run 2/10/2010 9:59:09Ah SAN JOMUIN COUNTY ENVIRONMENTAL HEAL"I DEPARTMENT Repo;1#5021 <br /> Run by Pagel <br /> Facility Information as of 2/10/20 <br /> Record Selection Criteria: Facility ID FA0018425 <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 OW0015140 New Owner ID <br /> Owner Name ANWAR, RERAN/KHAN, KASHIF <br /> Owner DBA VALLEY SMOG & REPAIR <br /> Owner Address 923 S CHEROKEE LN <br /> LODI, CA 95240 <br /> Home Phone 209-334-0305 <br /> Work/Business Phone Not Specified <br /> Mailing Address 923 S CHEROKEE LN <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018425 <br /> Facility Name VALLEY SMOG & REPAIR <br /> Location 923 S CHEROKEE LN <br /> LODI, CA 95240 <br /> Phone 209-334-0305 '1 1 <br /> Mailing Address :__ _ _ . _ <br /> .._ _.--- E .3 `oZ 5 � . 4, \eVv� 11N LY. <br /> LODI, CA 95240 <br /> Care of REHAN ANWAR <br /> Location Code 02 - LODI Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 04739006 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name REHAN ANWAR <br /> Title <br /> Day Phone 209-334-0305 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032529 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name VALLEY SMOG & REPAIR (Circle One) <br /> Account Balance as of 2/10/2010: $362.00 <br /> (Circle One) <br /> Transfer to Actwennactve <br /> PmgramdElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO527266 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO528777 Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO527217 EE5555555-Garrett Alias-Backus Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO531579 Active 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 pmlect spec,PFIS/EFID hourly charges associated with this <br /> facility or activity will be billed to the party idenfified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes andlor Standards and <br /> State and/or Federal Laws. (1 \t\ <br /> APPLICANT'S SIGNATURE: See— M(YQ W�11 "A o Date <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 Received by <br /> REHS: Date / / Account out: Date Z / \O /%() <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />