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Date run 12/30/2014 11:53:451 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/30/2014 <br /> Record Selection Criteria: Facility ID FA0019100 <br /> Make changes/corrections 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 to <br /> Owner ID OW0018137 New Owner ID : <br /> Owner Name—�-Snl In <br /> Owner DBA NISSAN KIA OF STOCKTON <br /> Owner Address 3077 E HAMMER LN <br /> STOCKTON, CA 95212 <br /> Home Phone 209-956-6500 <br /> Work/Business Phone 209-956-6500 <br /> Mailing Address p0 BO <br /> STOCKTON, CA 95269-1180 r y -Z' <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019100 10187055 <br /> Facility Name STOCKTON NISSAN <br /> Location 3077 E HAMMER LN <br /> STOCKTON, CA 95212 <br /> Phone 209-956-6500 X <br /> Mailing Address PO BOX 691180 `j0 7 7 C M ma C Ln <br /> STOCKTON, CA 95269-1180 SAor kaon �/t al <br /> Care oL.Segt{-$7tjffin„ <br /> Location Code 01 -STOCKTON Alt Phone <br /> SOS District 003- BESTOLARIDES Fax <br /> APN 12618019 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION ,�� 1_ (�,, <br /> Contact Name RON AGUTAR /�L.0O3t6 'taclkt)qy cyltLA <br /> Title SERVICE MGR 00 Sc-10+-t S r1 ;4Fi rn <br /> Day Phone 209-956-6500 00rhS 4K<e ercl no <br /> Night Phone one Q.1et- Cru\ p <br /> ACCOUNTS RECEIVABLE FILE INFORMATION O �v x 0p >;O <br /> 11�Q Mai\� a+olclrpSS <br /> Account ID AR0034013 l S 3p 7—) 3 kLplaw� °w Accc ID: <br /> Mail Invoices to Facility $fijc.c.ipn Ch 9S a I a l' Owner / Facility / Account <br /> Account Name STOCKTON NISSAN rrCC^ ��yy <br /> .�. a t I S Y61['/1 K (Ci(de One) <br /> Account Balance as of 12/30/2014: $0.00 <br /> (Circle One) <br /> PmgraMEtement and Description Record ID Employee Transfer to Active/Inactve <br /> ID and Name Status New Owne 1i Delete <br /> 1921 -HMBP-Regular-Primary Location PRO528772 EE0000006-HAZA SAEED Active Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PRO528320 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 2831-AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO528319 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0528247 EE0002620-ALFONSO ARAMBULA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533074 lr ivE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor projeO specRc,PHSIEHD 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 ell operations will be partonned in accordance with all applicable Ordinance Codes anivor Standards and State andror <br /> Federal Laws. <br /> APPLICANTS 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 Receive by <br /> REHS: �aCbGIR�..� 1 w..LP,>L _i Date �Z / Q/ I l Account out: Date <br /> COMMENrS: �— <br />