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RePad#5021 <br /> Pagel <br /> Date run 1/29Y�4 11:10:45A1 SAN JOIN COUNTY ENVIRONMENTAL HEA*DEPARTMENT <br /> Ranby Facility Information as of 1129/2014 <br /> Record Selection Criteria'. Facility ID FA0021420 Make changeslcorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE CHANGE(date) <br /> SSNI Fed Tax ID <br /> OWNER FILE INFORMATION New Owner ID <br /> owner ID oWO017616 <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 Not Specified <br /> Mailing Address 4119 CORONADO AVE <br /> STOCKTON, CA 95204 <br /> Care of <br /> FACILITY FILE INFORMATION 10187885 <br /> Facility ID/CERS ID FA0021420 <br /> Facility Name RD AUTOMOTIVE <br /> Location 4119 CORONADO AVE <br /> STOCKTON, CA 95204 <br /> Phone 209-808-1986 <br /> Mailing Address 4119 CORONADO AVE <br /> STOCKTON, CA 95204 <br /> Care of Alt Phone <br /> Location Code 01 - STOCKTON Fax <br /> Bos District 002-RUHSTALLER, LARRY EMail: <br /> APN 11531003 <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION New Account ID: <br /> Account ID AR0038785 Mail Invoices to: owner I Facility / Account <br /> Mail Invoices to Facility (Cade one) <br /> Account Name RD AUTOMOTIVE <br /> Account Balance as of 1/2912014: $0.00 (Cirde One) <br /> Transfer to Active/Ini <br /> Program/Element and Description Record ID Employee ID and Name <br /> Status New 0.0 Delete <br /> Active Y N A I D <br /> 1920-HMBP-Common Materials PRO538042 EE0002620-ROBERT LOPEZ Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0538042 EE0e,sekn that <br /> ARAMBULA PHSrEHD hourly charges associated with this fadllty <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator a agent of same,acknowledge that ell site,endor protect applicable <br /> specific, <br /> or activity will be billed to the party identified as the OWNER on this form. lalsocertifythal all operations will be performed <br /> in accordance with all eppliwble Ortlinanca Codes endor Standards and Stele endor <br /> Federal Laws <br /> Date <br /> APPLICANT'S SIGNATURE: <br /> ' <br /> Amount Paid Date_/_I-- <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Race'Od y <br /> Payment Type Check Number Date <br /> Date_�,/ / Account out: <br /> REHS: � <br /> COMMENTS: <br /> Pkb,63, ,�, ' I <br />