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Date run 4/26/2010 11:24:36AI SAN J--QUIN COUNTY ENVIRONMENTAL HEA'—a DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/26/2bimm <br /> Record Selection Criteria: Facility ID FA0016566 <br /> Make changes/comections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013420 New Owner ID <br /> Owner Name TAYLOR, ROBERT B <br /> Owner DBA TAYLOR AUTOMOTIVE <br /> Owner-Address 18711 MONTE VISTA DR <br /> LINDEN, CA 95236 <br /> Home Phone 209-931-6007 <br /> Work/Business Phone Not Specified <br /> Mailing Address 18711 MONTE VISTA DR <br /> LINDEN, CA 95236 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016566 <br /> Facility Name TAYLOR AUTOMOTIVE <br /> Location 2835 CHERRYLAND AVE STE 6 �_ +Zia L 7 /Fw cTr� � <br /> STOCKTON, CA 95215 <br /> Phone 209-931-6007 <br /> Mailing Address 18711 MONTE VISTA DR <br /> LINDEN, CA 95236 <br /> Care of TAYLOR, ROBERT <br /> Location Code 99-UNINCORPORATED A Alt Phone <br /> BOS District 002- RUHSTALLER, LARRY Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name TAYLOR, ROBERT <br /> Title <br /> Day Phone 209-931-6007 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029214 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name TAYLOR AUTOMOTIVE (Circle One) <br /> Account Balance as of 4/26/2010: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inde <br /> Programs Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO524667 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO526536 Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0533650 Active Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS/EHD houry charges associated with ins <br /> facility or activity will be billed to the party Identified as the OWNER on this form. I also certify that all operations wi11 be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> NI�PLICANTS SIGNATURE: Date C54/_ tz'/tea <br /> T 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 Receiv <br /> RENS: Date ?.�. /_�_ A unt out: Date <br /> COMMENTS: ky/ fJ/n rr+ <br /> \\eh-envkenvision\reportskB021.rpt <br />