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Date tin 12/27/2017 8:32:04A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by DONNA Pagel <br /> ' Facility Information as of 12/27/2017 <br /> Record Selection Crilena: Facility ID FA0004959 <br /> Make changeslcorrections in RED Ink. <br /> INFORMATION CHANGE(date) 3- `- -7/1 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0014626 New Owner ID <br /> Owner Name mansoor karimi <br /> Owner DBA <br /> OwnerAddress 2111 CABANA LN <br /> TRACY, CA 95377 <br /> Home Phone 209-640-0394 <br /> Work/Business Phone 209-463-9400 <br /> Mailing Address noT r. TLJCp nni oof <br /> Care of KARIMI, MANSOOR <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0004959 10181699 <br /> Facility Name TRI VALLEY AUTO DISMANTLERS <br /> Location 930 E DR MARTIN LUTHER KING JR BLVC <br /> STOCKTON, CA 95206 <br /> Phone 209-463-9500 x <br /> Mailing Address gag In PRMART-Ili I VD <br /> ST6GKT0Nr A 9F20R — <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 16718303 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 AR0005401 New Account ID: <br /> Mail Invoices to Facility b\ Mail Invoices to: Owner / Facility / Account <br /> Account Name TRI VALLEYAUTO DISMANTLERS (Circle One) <br /> Account Balance as of 12/27/2017: $3,531.65 <br /> 3� (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description / Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0521105 EE0009817-ROBERT LOPEZ Active Y N A ® D <br /> 2217-APPLIANCE RECYCLER PRO521609 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0517682 EE0000026-CESAR RUVALCABA Active Y N A I(!) D <br /> 2220-SM HW GEN<5 TONSNR PRO521746 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO517681 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO500994 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO517683 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523946 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRI05-34579 Inactive Y N A I D <br /> h�e�:,, I r�-l.�.m ti nd t� ���`T'��j �v>✓ve reloc.�-ed I a �� � �., ts-e <br /> V e� C <br />