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DM. 8/2/2017 4:OT05PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT aepona51n1 <br /> lsuh by Papel <br /> Facility Information as of 8/2/2017 <br /> Re S....Cdlerla: Felled,I FA0010953 <br /> Make chengee/correctlons In RED Ink. <br /> INFORMATION CHANGE(date) b& b7 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax 1D : <br /> Owner ID OW0008953 Case Number: H09961 New Owner ID : ' <br /> Owner Name TRI FORCE SOLUTIONS W TNC <br /> Owner DBA BIG 0 TIRES Q S <br /> Owner Address 1129 W 11TH ST 1112q IA`%�C <br /> TRACY, CA 95376 1T2 537 <br /> Home Phone 209-836-2683 �q <br /> Work/Business Phone 209-836-9145 $b- 2 <br /> Mailing Address 1129 W 11TH ST 111q W 11 sua <br /> TRACY, CA 95376 IVAN. CA COV-10 <br /> care or AMARJIT DALE <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0010953 10183965 �01$�fp5 <br /> Facility Name BIG 0 TIRES Wk D '{lots <br /> Location 1129 W ELEVENTH ST 1119 k1 [IV $11rCLt <br /> TRACY, CA 95376 JrAQ, Ca A W <br /> Phone 209-636-2683 (20q R3 —Y4 <br /> Mailing Address 1129 W 11TH ST ±4t <br /> TRACY, CA 95376 17avq I CA Camp <br /> Care of <br /> Location Code 03-TRACY Alt Phone <br /> Bos District 005-ELLIOTT, BOB Fax <br /> APN 23229068 EMail: Tsimovic PCiIIIAIL• COM <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> ContactName AMARJIT(SINGH) DALE 7AFASSIAA K96N OR SWhIA ARIF <br /> Title <br /> Day Phone 209-836-2683 oq 0S —07 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017953 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner r Facility / Account <br /> Account Name BIG O TIRES (Chola one) <br /> Account Balance as of 8/2/2017: $0.00 <br /> (OrWii One) <br /> Transfer Atl,vell <br /> Pm,;ns"Elemiption ent sM Del It coN ID Employee ID and Nam° slMsw IJw <br /> aa O <br /> Naw nO(I Delete <br /> 2220-SM HW GEN<5 TONSlYR PRO536959 EE0000016-BETTY HO ActiveY N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513241 EE0000000-HAZ MAT SJC OES Inactive N A I D <br /> 4740-WASTETIRE SITE-EXEMPT PRO510953 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE FEE PRO537009 Inactive Y N A I D <br /> BIWNO and COMPLIANCE ACKNOWLEDGEMENT: I,Ne uManlp ial ow ner,apemt.,orepeN-Is--,ecknowbdga Mal all elle,arwar pl.j.d eP.Nfc.WH HD howl,chary.,associated wan Mbiadllty <br /> or actlrity we ha Wild to the party Idenbped as are OWNER an this Mm. I mw adiy that all operations.,I11 be pedommd N amorksma with all app0abl. ordinance codes an bor standards and met.andbr <br /> Federal Laws. p. <br /> APPLICANTS SIGNATURE: ---R Date DO <br /> Program Records to be TRANSFE D: / '525.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paitl Date_/_I_ 1rr <br /> Payment Type Check Number Received by e <br /> EHD Staff. te / / Account out: Date <br /> COMMENTS: _ <br /> Invoice#: <br /> �GTIi✓�.7� 2 ZZ� � vlfzl.-, �'�,-,..tom_ ���ullS <br />