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Date run 12/27/2017 1:26:32P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/27/2017 <br /> Record Selection Criteria: Facility ID FA0010791 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0008791 New Owner ID <br /> Owner Name THOMPSON, JAMES E JR 2: 6 1)10136 ij <br /> Owner DBA AUTO SPECIALTIES <br /> Owner Address 1905 LONE FOX CT 10/ W. r/6Jetg Sy" <br /> TRACY, CA 95376 C4 ri 3 O q <br /> Home Phone Not Specified <br /> Work/Business Phone 209-833-3880 <br /> Mailing Address 7918 W 11TH ST <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010791 10183823 <br /> Facility Name AUTO SPECIALTIES <br /> Location 7918 W ELEVENTH ST <br /> TRACY, CA 95304-9303 <br /> Phone 209-833-3880 x <br /> Mailing Address 7918 W 11TH ST <br /> TRACY, CA 95304 <br /> Care of JAMES E THOMPSON JR I L,OAJ D 0 <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 25015001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATIO�Ipn. [rT <br /> Contact Name rT 6P' LO N'DbA) <br /> Title <br /> RECE � 1�y to — 61 ,"T t <br /> Day P <br /> Night Phone DEC <br /> 2 loll <br /> ACCOUNTS RECEIVABLE FILE INFORMATION �p 'wiNTM <br /> coUN <br /> Account ID AR0017791 E TMRDEPARluENT New Account ID: <br /> Mail Invoices to Account H Mail Invoices to: Owner / Facility / Account <br /> Account Name AUTO S 1 (Circle One) <br /> Account Balance as of 12/27/20 7: $472.00 <br /> (Circle One) <br /> Transfer to Active'Ini <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PRO521185 ✓EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514419 EE9999997-TWO VACANT2 Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513079 EE9999997-TWO VACANT2 Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510791 EE000o000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534188 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,PI-Si 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 andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! / <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid DaI <br /> Water System to b T NSFERED: Amount PoM" Y/o(V(1, Date 11 <br /> Payment Type Check Number 7b I I Received g <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> Invoice#: <br />