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Date run : 1/31/2007 2:09:51 P6 SAN JOOUIN COUNTY ENVIRONMENTAL HEA16 DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1131120Cr! <br /> Record Selection Criteria: Facility ID FA0004959 <br /> Make changeslcorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0014626 New Owner ID <br /> Owner Name MARTIN, TODD A <br /> Owner DBA <br /> Owner Address 3472 ENTERPRISE AVE <br /> HAYWARD, CA 94545 <br /> Home Phone 510-575-6041 <br /> WorklBusiness Phone 209_943-9004 <br /> Mailing Address 3472 ENTERPRISE AVE <br /> HAYWARD, CA 94545 <br /> Care of MARTIN, TODD A <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004959 <br /> Facility Name CHARTER WAY AUTO DISMANTLERS <br /> Location 930 E CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-943-9004 <br /> Mailing Address �pI lc� Cha I A ,� <br /> STOCKTON, CA 96206 4 S 7'D c <br /> Care of MARTIN, TODD A <br /> Location Code 01 -STOCKTON APN:1671$30315 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005401 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility / Account <br /> Account Name CHARTER WAY AUTO DISMANTLERS (Circle One) <br /> Account Balance as of 113112007: $230.00 <br /> (Circle One) <br /> Trartsferto Activellnactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2217-APPLIANCE RECYCLER PRO521509 EE0008317-RAYMOND VON FLUE Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0517682 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO521746 EE0008317-RAYMOND VON FLUE Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO517681 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0521105 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0500994 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR,PR0517683 EE0000008-LETITIA BRIGGS Inactive Y N A i D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0523946 EE0000060-JENNIFER RUIZ Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSlEHD hourty charges associated with this <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: 5 e_eDate <br /> Oma\ 0. q 11 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date I I <br /> Water System to be TRANSFERED: "$372.00= Amount Paid Date ! / <br /> Payment Type Check Number Received by <br /> REHS: Date / I Account out: Date V /3�_! 0 l <br /> COMMENTS: <br /> Ilp hs-ehsgl-ntlappslenvisionslreports15021.rpt <br />