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Data ran 2/16/2016 10:57:03AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/18/2016 <br /> Record Selection Criteria: Facility ID FA0020015 <br /> Make changeslcorrections 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 OW0016428 New Owner ID <br /> Owner Name WILLIAM LUTHER/WINCHELL, JASON <br /> Owner DBA <br /> Owner Address 13336 E HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Home Phone 209-797-5045 <br /> Work/BusinessPhone 209-851-1674 <br /> Mailing Address PO BOX 929 <br /> LOCKEFORD, CA 95237 <br /> Care of WINCHELL, JASON <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0020015 10187487 <br /> Facility Name J and H smog and repair <br /> Location 13336 E HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Phone 209-797-5045 x <br /> Mailing Address PO BOX 929 <br /> LOCKEFORD, CA 95237 <br /> Care of JASON WINCHELL <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-WINN, CHARLES Fax <br /> APN 01902044 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name WINCHELL, JASON <br /> Title <br /> Day Phone 209-797-5045 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0035640 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name J A H SMOG AND RE IR (Circle One) <br /> Account Balance as of 2/18/ 16: $709.00 <br /> (Circle One) <br /> Transfer to Activellnachne <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 2220-SM HW GEN<5 TONSNR PR0636729 EE0001422-ARIS VELOSO Active Y N A 1 D <br /> ASTE TIRE SITE-EXEMPT 0002620-ALFONSOARAMBULA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO536730 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will ba billed to the party identified as the OWNER on this form. I also certify Nal all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and Stale andor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Type Check Number Received by <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> Invoice#: <br /> X11 (e vv� tV\ckkCOakes �ot�x IS vac(. ��/ Tco` A # aA Ili-1614 <br /> 0.nd ?evs0r\ 6l %\'ncsi c10542d -s- - leo--sc 0.dV112 <br />