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Date run 9/16/2014 3:17:12PR SAN JO IN COUNTY ENVIRONMENTAL HEAS DEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 9/16/2014 <br /> Record Selection Criteria: Facility ID FA0021420 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSNIFed Tax ID : <br /> Owner ID OW0017616 New Owner ID <br /> Owner Name ROBERT DIAZ <br /> Owner DBA RD AUTOMOTIVE <br /> Owner Address 4119 CORONADO AVE <br /> STOCKTON, CA 95204 <br /> Home Phone 209-808-1986 <br /> Work/Business Phone 209-346-0374 <br /> Mailing Address 4119 CORONADO AVE <br /> STOCKTON, CA 95204 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0021420 10187885 <br /> Facility Name RD AUTOMOTIVE <br /> Location 4119 CORONADO AVE <br /> STOCKTON, CA 95204 <br /> Phone 209-808-1986 x <br /> Mailing Address 4119 CORONADO AVE <br /> STOCKTON, CA 95204 <br /> Care of RD Automotive <br /> Location Code 01 -STOCKTON Alt Phone <br /> Bos District 002- RUHSTALLER, LARRY Fax <br /> APN 11531003 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0038785 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name RD AUTOMOTIVE (Circle One) <br /> Account Balance as of 9/16/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inache <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0537304 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0538629 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO538042 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned!owner,operator or agent of same,acknowledge that all site,anNor project specific,PHl hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andror Standards and State anNor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date ! / <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Type Check Number Received by <br /> REHS: Date / I Account out: Date <br /> COMMENTS: <br />