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Date run 201/2010 3:00:06PN SAN.Y' WIN COUNTY ENVIRONMENTALHEj' -HDEPARTMENT Report#5021 <br /> Run by - 1273 Pagel <br /> Facility Information as of 2/11/'�Td <br /> Record Selection Criteria: Facility ID FA0009463 <br /> 1 <br /> "I f1� Make changes/corrections in RED ink. <br /> fk,� INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007463 Case Number: H04193 New Owner ID <br /> Owner Name PANAGOPOULOS,WILLIAM <br /> Owner DBA AUTOMOTIVE DIESEL SVC &GEN RE <br /> Owner Address 833 S COMMERCE ST <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-957-3632 <br /> Mailing Address 833 S COMMERCE ST 8-X, O'9 7`7 <br /> STOCKTON, CA 952061276 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009463 <br /> Facility Name AUTOMOTIVE DIESEL SVC&GEN REPAIR <br /> Location 833 S COMMERCE ST <br /> STOCKTON, CA 95206 <br /> Phone 209466-1071 <br /> Mailing Address 833 S COMMERCE ST T,19 lex "A al B*Z7 <br /> STOCKTON, CA 952061276 _!�—I-� 'D 77 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 14710502 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name WILLIAM K PANAGOPOULOS <br /> Title PARTNER(OWNER) <br /> Day Phone 209-466-1071 <br /> Night Phone 209-957-3632 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016463 � New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name AUTOMOTIVE DIESEL SVC &GEN REPAIR (Chas Ona) <br /> Account Balance as of 2/11/2010: $262.00 <br /> (Circle One) <br /> Transfer to Act!"Anechre <br /> P m emem and Description Record ID Employee ID and Name Status New Owner'! Delete <br /> 2220 IM HW GEN c5 TONS/YR PR0513853 EE0008317-RAYMOND ON FLUE Active Y N A I D <br /> -HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511751 EE0000O00-HAZ MAT S C OES Inactive Y INA D <br /> 2244-PACT TRANSFER RECORD-OES PRO519647 EE0000000-HAZ MAT SJP OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0509463 EE0000000-HAZ MAT SJP OES Inactive Y N A .Its D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0531819 Active Y N A I ' D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator"agent of samacknowledge a all site,antler project e,acknopacific,PHS/EHD hourly charges associated with this <br /> facility or ac"will be billed to Ne party identified as the OWNER on this form. I also cervly that all operations wall be at in a rice with all appkable Ordinace Codes and/or Standards and <br /> State anNor Federal Laws. ✓ _e <br /> Ptd �� titiY pP 2q22® -rt- Allju�� �- <br /> APPLICANT'S SIGNATURE: 4- ?! Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date / / y D <br /> Payment pe Check Number Receive <br /> REHS: I Date / / Account out: Date l 110 <br /> /y�DJ1G_fl^/(1� � i&, <br /> \tehenv\envisionnXr(elpoorrtskS021.rpt �"`""----~ � �L/I It <br /> l Iro <br />