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Date run 11/2/2017 3:28:35PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/2/2017 <br /> Record Selection Criteria: Facility ID FA0009745 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN 1 Fed Tax ID <br /> Owner ID OW0007745 Case Number: H05317 New Owner ID <br /> Owner Name WEGAT, HOWARD JR <br /> Owner DBA WEGAT'S TRUCK REPAIR <br /> OwnerAddress 23192 N DUSTIN RD <br /> ACAMPO, CA 95220 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-334-1744 <br /> Mailing Address PO BOX 261 <br /> ACAMPO, CA 95220 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID J CERS ID FA0009745 10182857 <br /> Facility Name WEGATS TRUCK REPAIR <br /> Location 23192 N DUSTIN RD <br /> ACAMPO, CA 95220 <br /> Phone 209-334-1744 x <br /> Mailing Address PO BOX 261 <br /> ACAMPO, CA 95220 <br /> Care of HOWARD WEGAT JR. <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 00705032 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 AR0016745 New Account ID: <br /> Mail Invoices to Acsol Mail Invoices to: Owner 1 Facility J Account f (M <br /> Account Name WEGA UCK REPAIR (Circle One) f`I <br /> fie_ 2� f f <br /> Account Balance as of 111212017: $455. �,�}�-_, �� i-- �'� <br /> l (�51 `(Circle One) <br /> Transferto Activednactve <br /> Program/Element and Description Record tD Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PRO519842 EE0008709-JAMIE LIMA Active Y N A (07) D <br /> 2220-SM HW GEN<5 TONSNR PR0514017 EE0000030-AARON HANG Active Y N A {1 ) D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512033 EE0000000-HAZ MAT SJC OES Inactive Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509745 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE PRO532723 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHStEHD 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 and'or Standards and State anther <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date 1 J <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date J J <br /> Water System to be TRANSFERED: Amount Paid Date J ! <br /> Payment Type Check.Number Received b <br /> EHD Staff: Date J Account out: Date 1Z / 7 11-7 <br /> COMMENTS: Invoice#: <br />