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Date mn 7/8/2015 9:17:55AM SAN J09LIN COUNTY ENVIRONMENTAL HEAG DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/8/2015 <br /> Record Selection Cdterie: 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 ID <br /> Owner ID OW0018137 New Owner ID <br /> Owner Name Lithia of Stockton Inc <br /> Owner DBA STOCKTON NISSAN <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 3077 E HAMMER LN <br /> STOCKTON, CA 95212 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/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 3077 E HAMMER LN <br /> STOCKTON, CA 95212 <br /> Care of Ron Aguilar <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 12618019 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name RON AGUTAR <br /> Title SERVICE MGR <br /> Day Phone 209-956-6500 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034013 New Account ID: <br /> Mail Invoices to Account Mail l nvoices to: Owner / Facility / Account <br /> Account Name Stockton Nissan (Circle One) <br /> Account Balance as of 7/8/2015: $39.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? 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 PR0528319 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO528247 EE0002620-ALFONSO ARAMBULA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533074 Inactivf Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor project specific,PHS/EHO hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also codify that all operations will be performed in accordance with all applicable Ordinance Codes andfor Standards and State anNor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: � 1���-/ 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 Re ed <br /> EHD Staff: Date / / Account out: Date�/ <br /> COMMENTS: <br /> Invoice#: <br />